Print E-mail
Volume 49, Number 3, June 2016

Comparisons between patients with trimethoprim–sulfamethoxazole-susceptible and trimethoprim–sulfamethoxazole-resistant Stenotrophomonas maltophilia monomicrobial bacteremia: A 10-year retrospective study 


Ching-Hsun Wang, Jung-Chung Lin, Hsin-An Lin, Feng-Yee Chang, Ning-Chi Wang, Sheng-Kang Chiu, Te-Yu Lin, Ya-Sung Yang, Li-Ping Kan, Chin-Hsuan Yang, Ming-Chin Chan, Kuo-Ming Yeh


 

Corresponding author:

Corresponding author. Kuo-Ming Yeh, Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Number 325, Section 2, Cheng-Kung Road, Neihu, Taipei 114, Taiwan. 



 

Background and purpose: 

The impact of bacteremia due to the resistance of Stenotrophomonas maltophilia to trimethoprim–sulfamethoxazole (TMP–SXT) is uncertain. This study compared the clinical characteristics and outcomes of patients with TMP–SXT-susceptible (TSSSM) and TMP–SXT-resistant S. maltophilia (TSRSM) monomicrobial bacteremia. 



 

Methods:

The medical records of adult patients with TSSSM and TSRSM monomicrobial bacteremia from January 2004 to December 2013 were reviewed and classified into two groups, namely, TSSSM and TSRSM. 



 

Results:

There were 184 patients with monomicrobial S. maltophilia bacteremia. The mean age was 68.3 years. Most patients were males (72.8%), had high Charlson Comorbidity Index scores, previously prescribed antimicrobial agents, and indwelling medical devices. The 14-day and in-hospital mortality rates were 23.9% and 47.2%, respectively. There were 128 patients (69.6%) with TSSSM and 56 (30.4%) with TSRSM. The incidence of TSSSM bacteremia increased during the study period. The TSSSM and TSRSM groups had similar demographic and clinical characteristics and no significant differences in 14-day and in-hospital mortality (24.2% vs. 23.2%, p = 0.833; 50.0% vs. 41.1%, p = 0.264, respectively). Patients with TSSSM bacteremia had an increased risk of septic shock (p = 0.044) and neutropenia (p = 0.028) at bacteremia onset. Logistic regression analysis indicated that acquisition of TMP–SXT resistance was an independent risk factor for prolonged hospitalization (p = 0.018) and catheter-related S. maltophilia bacteremia was inversely associated with prolonged hospitalization after bacteremia (p = 0.032).

 



 

Conclusion:

There were no significant differences in mortality for patients with TSSSM and TSRSM bacteremia, but patients with TSRSM bacteremia were associated with prolonged hospitalization after bacteremia onset. 



 

Key words:

bacteremia, resistance, Stenotrophomonas maltophilia, trimethoprim–sulfamethoxazole