225. Risk Factors for Mortality in Stenotrophomonas Bacteremia: A Retrospective Study. (4th December 2021)

• Record Type: Journal Article
• Authors: Huang, Glen; Davis, Matthew R; Allyn, Paul R
• Is Part Of: Open forum infectious diseases. Volume 8(2021)Supplement 1
• Page Start: S220
• Page End: S220
• Publication Date: 2021-12-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofab466.427
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Stenotrophomonas is a gram-negative organism typically associated with nosocomial infections. It is an emerging multi-drug resistant pathogen associated with significant morbidity and mortality in hospitalized patients. Optimal therapy is unknown. In this study, we evaluated the impact of treatment agent, dosing regimen, and patient characteristics on 30-day mortality for Stenotrophomonas bacteremia in our hospital system. Methods: Retrospective chart review from April 2013 to September 2019 at Ronald Reagan and Santa Monica UCLA Medical Centers in Los Angeles, California. Adult patients who were hospitalized and received active therapy for Stenotrophomonas bacteremia were included in the study. Chi-square or Fischer test was used for categorical variables, Student's t-test or Mann-Whitney U test was used for continuous variables. Results: Sixty-nine patients were included in the study. The median age was 53 and 31 patients (44.9%) were female. Central line associated infections were the most common source of infection (79.7%, n = 55). Two patients (3%) had a relapse of infection. The overall 30-day mortality was 30.4% (n=21). The patients who did not survive to 30 days tended to have a higher Pitt bacteremia score, a longer length of stay, and were more likely to have used other antibiotics in the 30 days prior to culture collection. Trimethoprim-sulfamethoxazole (TMP-SMX) was the most common antibiotic used for treatment (n = 45, 65.2%). Of the patients who were treated with TMP-SMX, 19 were treated with high-dose (defined as 15 mg/kg or equivalent) and 26 had an alternative dosage after adjusting for renal function. There was no difference in 30-day mortality in the TMP-SMX high dose vs alternative dose (42.1% vs 30.8%, p = 0.53). Conclusion: Stenotrophomonas bacteremia was associated with high mortality. High-dose TMP-SMX did not impact survival in our study; however, this may be due to small sample size. More research is needed to determine optimal therapy. Disclosures: All Authors : No reported disclosures