Ventilator-associated pneumonia due to Stenotrophomonas maltophilia: Risk factors and outcome

嗜麦芽窄食单胞菌 呼吸机相关性肺炎 医学 肺炎 重症监护室 内科学 机械通风 碳青霉烯 铜绿假单胞菌 重症监护医学 抗生素 微生物学 生物 遗传学 细菌
作者
Wafa Ibn Saied,Sybille Merceron,Carole Schwebel,Alban Le Monnier,Johana Oziel,Maïté Garrouste-Orgeas,Guillaume Marcotte,Stéphane Ruckly,Bertrand Souweine,Michaël Darmon,Lila Bouadma,Étienne de Montmollin,Bruno Mourvillier,Jean Reignier,Laurent Papazian,Shidasp Siami,Élie Azoulay,Jean‐Pierre Bédos,Jean‐François Timsit
出处
期刊:Journal of Infection [Elsevier BV]
卷期号:80 (3): 279-285 被引量:53
标识
DOI:10.1016/j.jinf.2019.10.021
摘要

Background Stenotrophomonas maltophilia (SM) is increasingly identified in intensive care unit (ICU). This study aim to identify risk factors for SM ventilator-associated pneumonia (VAP) and whether it affects ICU mortality Methods Two nested matched case-control studies were performed based in OUTCOMEREA database. The first episodes of SM-VAP patients were matched with two different control groups: VAP due to other micro-organisms (VAP-other) and Pseudomonas aeruginosa VAP (Pyo-VAP). Matching criteria were the hospital, the SAPS II, and the previous duration of mechanical ventilation (MV). Results Of the 102 SM-VAP patients (6.2% of all VAP patients), 92 were matched with 375 controls for the SM-VAP/other-VAP matching and 84 with 237 controls for the SM-VAP/Pyo-VAP matching. SM-VAP risk factors were an exposition to ureido/carboxypenicillin or carbapenem during the week before VAP, and respiratory and coagulation components of SOFA score upper to 2 before VAP. SM-VAP received early adequate therapy in 70 cases (68.6%). Risk factors for Day-30 were age (OR = 1.03; p < 0.01) and Chronic heart failure (OR = 3.15; p < 0.01). Adequate treatment, either monotherapy or combination of antimicrobials, did not modify mortality. There was no difference in 30-day mortality, but 60-day mortality was higher in patients with SM-VAP compared to Other-VAP (P = 0.056). Conclusions In a large series, independent risk factors for the SM-VAP were ureido/carboxypenicillin or carbapenem exposure the week before VAP, and respiratory and coagulation components of the SOFA score > 2 before VAP. Mortality risk factors of SM-VAP were age and chronic heart failure. Adequate treatment did not improve SM-VAP prognosis.
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