Appropriate antibiotic therapy is a predictor of outcome in patients with Stenotrophomonas maltophilia blood stream infection in the intensive care unit

Lai, Jiun-Ji; Siu, L. Kristopher; Chang, Feng–Yee; Lin, Jung‐Chung; Yu, Chun Yen; Wu, Ruixue; Wang, Ching-Hsun

doi:10.1016/j.jmii.2023.03.001

Cited by 10 publications

(4 citation statements)

References 41 publications

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“…However, the continuous increase in the number of non-susceptible isolates is cause for concern. SXT-resistance may develop through a variety of molecular mechanisms, in which case, other therapeutic modalities need to be considered [ 52 ]. In the systematic review and meta-analysis of Prawang et al., favourable outcomes were noted for combination therapy, however, during subgroup analysis, combination therapy was associated with higher mortality risk in specific patient groups [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Correlation between Stenotrophomonas maltophilia incidence and systemic antibiotic use: A 10-year retrospective, observational study in Hungary

Gajdács,

Matuz,

Ria

et al. 2024

EuJMI

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Extensive use of carbapenems may lead to selection pressure for Stenotrophomonas maltophilia (SM) in hospital environments. The aim of our study was to assess the possible association between systemic antibiotic use and the incidence of SM. A retrospective, observational study was carried out in a tertiary-care hospital in Hungary, between January 1st 2010 and December 31st 2019. Incidence-density for SM and SM resistant to trimethoprim-sulfamethoxazole (SXT) was standardized for 1000 patient-days, while systemic antibiotic use was expressed as defined daily doses (DDDs) per 100 patient-days. Mean incidence density for SM infections was 0.42/1000 patient-days; 11.08% were were resistant to SXT, the mean incidence density for SXT-resistant SM was 0.047/1000 patient-days. Consumption rate for colistin, glycopeptides and carbapenems increased by 258.82, 278.94 and 372.72% from 2010 to 2019, respectively. Strong and significant positive correlations were observed with the consumption of carbapenems (r: 0.8759; P < 0.001 and r: 0.8968; P < 0.001), SXT (r: 0.7552; P = 0.011 and r: 0.7004; P = 0.024), and glycopeptides (r: 0.7542; P = 0.012 and r: 0.8138; P < 0.001) with SM and SXT-resistant SM incidence-density/1000 patient-days, respectively. Implementation of institutional carbapenem-sparing strategies are critical in preserving these life-saving drugs, and may affect the microbial spectrum of infections in clinical settings.

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Section: Discussionmentioning

confidence: 99%

Correlation between Stenotrophomonas maltophilia incidence and systemic antibiotic use: A 10-year retrospective, observational study in Hungary

Gajdács,

Matuz,

Ria

et al. 2024

EuJMI

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“…Multidrug-resistant S. maltophilia strains SMYN41–SMYN45 from the community are susceptible to SXT and do not possess SXT-related resistance genes. Studies have found that fluoroquinolone-containing regimens may be a better option than SXT-containing regimens in treating S. maltophilia -related infections ( Mojica et al., 2016 ; Lai et al., 2023 ). Therefore, the treatment of choice for S. maltophilia infections remains unclear when the strain is susceptible to both SXT and quinolones.…”

Section: Discussionmentioning

confidence: 99%

Comparative genomics analysis of Stenotrophomonas maltophilia strains from a community

Li,

Liu,

Chen

et al. 2023

Front. Cell. Infect. Microbiol.

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BackgroundStenotrophomonas maltophilia is a multidrug-resistant (MDR) opportunistic pathogen with high resistance to most clinically used antimicrobials. The dissemination of MDR S. maltophilia and difficult treatment of its infection in clinical settings are global issues.MethodsTo provide more genetic information on S. maltophilia and find a better treatment strategy, we isolated five S. maltophilia, SMYN41–SMYN45, from a Chinese community that were subjected to antibiotic susceptibility testing, biofilm formation assay, and whole-genome sequencing. Whole-genome sequences were compared with other thirty-seven S. maltophilia sequences.ResultsThe five S. maltophilia strains had similar antibiotic resistance profiles and were resistant to β-lactams, aminoglycosides, and macrolides. They showed similar antimicrobial resistance (AMR) genes, including various efflux pumps, β-lactamase resistance genes (blaL1/2), aminoglycoside resistance genes [aac(6’), aph(3’/6)], and macrolide-resistant gene (MacB). Genome sequencing analysis revealed that SMYN41-SMYN45 belonged to sequence type 925 (ST925), ST926, ST926, ST31, and ST928, respectively, and three new STs were identified (ST925, ST926, and ST928).ConclusionThis study provides genetic information by comparing genome sequences of several S. maltophilia isolates from a community of various origins, with the aim of optimizing empirical antibiotic medication and contributing to worldwide efforts to tackle antibiotic resistance.

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“…However, primary BSI was not reported as a risk factor for excess mortality. Early administration of adequate antimicrobials is accepted as a fundamental of management, and studies continue to be reported supporting this goal [33]. Sex related differences in ICU admission, treatments offered, and outcome is becoming an increasing topic of interest.…”

Section: Outcome Treatment and Costmentioning

confidence: 99%

Central line associated and primary bloodstream infections

Stewart,

Laupland,

Tabah

2023

Current Opinion in Critical Care

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Purpose of review Primary and intravascular catheter-associated bloodstream infections (CA-BSIs) represent an important clinical entity in the intensive care unit (ICU) being associated with significant morbidity and mortality. The purpose of this review was to examine the recently published data on epidemiology and management of CA-BSI and other primary BSIs specifically within the context of the ICU. Recent findings In critically ill patients, the pooled prevalence of primary and CA-BSI from contemporary studies was 19.7–40.7% and 26.4–37.3% of all BSIs, respectively. Failure to achieve source control (i.e., removal of catheter in CA-BSI) is associated with higher mortality. Higher severity scores and durations of ICU stay and catheter insertion are well established risk factors for CA-BSI. The use of prevention bundles when inserting a central venous line is able to reduce CA-BSI incidence from 4 to 1.6 episodes per 1000 central venous catheter days. Differential time-to-positivity of paired blood cultures may assist in the diagnosis of CA-BSI. Summary Primary BSI is frequently observed in ICU cohorts and has a poor effect on outcome. Surveillance for BSI among patients admitted to ICUs is fundamental to inform healthcare service delivery, design preventive approaches, to track resistance, and detect emerging pathogens.

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Appropriate antibiotic therapy is a predictor of outcome in patients with Stenotrophomonas maltophilia blood stream infection in the intensive care unit

Cited by 10 publications

References 41 publications

Correlation between Stenotrophomonas maltophilia incidence and systemic antibiotic use: A 10-year retrospective, observational study in Hungary

Correlation between Stenotrophomonas maltophilia incidence and systemic antibiotic use: A 10-year retrospective, observational study in Hungary

Comparative genomics analysis of Stenotrophomonas maltophilia strains from a community

Central line associated and primary bloodstream infections

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