Mortality and exacerbations associated with Stenotrophomonas maltophilia in chronic obstructive pulmonary disease. A regional cohort study of 22,689 outpatients

Abstract

Objectives The clinical significance of Stenotrophomonas maltophilia in patients with COPD is poorly understood. We aimed to determine whether a lower respiratory tract culture positive for S. maltophilia in COPD patients was independently associated with increased risk of death and hospitalisation for exacerbation of COPD. Methods An observational cohort study following outpatients with COPD in Eastern Denmark between 2010 and 2018, with a follow-up period of five years. Presence of S. maltophilia was treated as a time-varying exposure, where patients were considered exposed at the time of the first isolation of S. maltophilia from the lower respiratory tract. The hazard ratio (HR) of death and hospitalisation for acute exacerbations of COPD was assessed using a Cox proportional hazards regression. Results Of the total 22,689 patients 459 (2.0%) had a lower respiratory sample positive for S. maltophilia. A total of 7,649 deaths (S. maltophilia positive: 243 (52.9%) and S. maltophilia negative: 7,406 (34.4%)) and 24,912 hospitalisations for exacerbation of COPD (S. maltophilia positive: 1,100 in 459 patients and S. maltophilia negative: 23,821 in 22,230 patients) were registered during the study period. We found that a lower respiratory tract culture positive for S. maltophilia was associated with both increased mortality: HR 3.3 (95% CI 2.6–4.3), and hospitalisation for exacerbation of COPD: HR 3.4 (95% CI 2.8–4.1). Conclusions A lower respiratory tract culture positive for S. maltophilia in COPD patients was associated with a substantially increased mortality and hospitalisation for exacerbation of COPD. Randomised controlled trials are proposed to determine whether S. maltophilia should be the target of antibiotic treatment.

Complicated bacterial lung infections in patients with COPD

“…I et nyligt publiceret registerstudie rapporteres tilsvarende dårlig prognose hos danske ambulante patienter med KOL og vaekst af S. maltophilia i nedre luftvej-prøver [12]. Dette er det første studie, hvor man undersøger sammenhaengen mellem bakterien og prognose i en større population af patienter med KOL, og resultaterne viser, at tilstedevaerelse af S. maltophilia var associeret med en tre gange højere risiko for indlaeggelse med eksacerbation af KOL og død end fravaer af S. maltophilia.…”

Antibacterial potential of Stenotrophomonas maltophilia complex cystic fibrosis isolates

“…The CF Foundation Infection Research Initiative recently identified S. maltophilia as an “area of need” for research ( 12 ). S. maltophilia also infects immunocompromised, cancer, COVID-19, and chronic obstructive pulmonary disease patients ( 8 , 13 , 14 ). Bloodstream infections can have mortality rates above 65% ( 15 ).…”

Inhaled corticosteroids andStenotrophomonas maltophiliain outpatients with chronic obstructive pulmonary disease: a retrospective cohort study

“… 19 In a recent study from our group, S. maltophilia in the lower respiratory tract was associated with a threefold increased risk of both hospitalisation-requiring exacerbation of COPD and death. 20 …”