Outcomes of Stenotrophomonas maltophilia hospital-acquired pneumonia in intensive care unit: a nationwide retrospective study.

Autor: Guerci P; Department of Anaesthesiology and Critical Care Medicine, Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy-Brabois, Vandoeuvre-Lès-Nancy, France.; INSERM U1116, Groupe Choc, University of Lorraine, Nancy, France., Bellut H; Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France., Mokhtari M; Department of Anaesthesiology and Critical Care Medicine, Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy-Brabois, Vandoeuvre-Lès-Nancy, France., Gaudefroy J; Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France., Mongardon N; Service d'Anesthésie-Réanimation, Hôpital Henri Mondor, DMU CARE, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm U955 équipe 3, Université Paris-Est Créteil, Créteil, France., Charpentier C; Réanimation Chirurgicale Polyvalente, Hôpital Central, Centre Hospitalier Universitaire de Nancy, Nancy, France., Louis G; Réanimation polyvalente, Hôpital de Mercy, CHR Metz-Thionville, Metz, France., Tashk P; Service d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France., Dubost C; Réanimation polyvalente, Hôpital d'Instruction des Armées (HIA) Bégin, Saint-Mandé, France., Ledochowski S; Service de Réanimation Polyvalente, Groupement Hospitalier Nord Dauphiné- Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France., Kimmoun A; Réanimation Médicale, Institut Lorrain du Cœur et des Vaisseaux, CHU Nancy-Brabois, Vandoeuvre-Lès-Nancy, France., Godet T; Réanimation Adultes et Soins Continus, Pôle de Médecine Péri-opératoire, Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France., Pottecher J; Service d'Anesthésie-Réanimation Chirurgicale, Hôpital Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.; Faculté de Médecine, Institut de Physiologie, EA3072, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France., Lalot JM; Service d'Anesthésie-Réanimation, Réanimation polyvalente, Centre Hospitalier Emile Durkheim, Epinal, France., Novy E; Department of Anaesthesiology and Critical Care Medicine, Institut Lorrain du Coeur et des Vaisseaux, University Hospital of Nancy-Brabois, Vandoeuvre-Lès-Nancy, France., Hajage D; Département Biostatistique Santé Publique Et Information Médicale, Unité de Recherche Clinique PSL-CFX, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, INSERM, Institut Pierre Louis de Santé Publique, Equipe Pharmacoépidémiologie et évaluation des soins, AP-HP, Hôpital Pitié-Salpêtrière, CIC-1421, Paris, France., Bouglé A; Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anaesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. adrien.bougle@aphp.fr.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2019 Nov 21; Vol. 23 (1), pp. 371. Date of Electronic Publication: 2019 Nov 21.
DOI: 10.1186/s13054-019-2649-5
Abstrakt: Background: There is little descriptive data on Stenotrophomonas maltophilia hospital-acquired pneumonia (HAP) in critically ill patients. The optimal modalities of antimicrobial therapy remain to be determined. Our objective was to describe the epidemiology and prognostic factors associated with S. maltophilia pneumonia, focusing on antimicrobial therapy.
Methods: This nationwide retrospective study included all patients admitted to 25 French mixed intensive care units between 2012 and 2017 with hospital-acquired S. maltophilia HAP during intensive care unit stay. Primary endpoint was time to in-hospital death. Secondary endpoints included microbiologic effectiveness and antimicrobial therapeutic modalities such as delay to appropriate antimicrobial treatment, mono versus combination therapy, and duration of antimicrobial therapy.
Results: Of the 282 patients included, 84% were intubated at S. maltophilia HAP diagnosis for duration of 11 [5-18] days. The Simplified Acute Physiology Score II was 47 [36-63], and the in-hospital mortality was 49.7%. Underlying chronic pulmonary comorbidities were present in 14.1% of cases. Empirical antimicrobial therapy was considered effective on S. maltophilia according to susceptibility patterns in only 30% of cases. Delay to appropriate antimicrobial treatment had, however, no significant impact on the primary endpoint. Survival analysis did not show any benefit from combination antimicrobial therapy (HR = 1.27, 95%CI [0.88; 1.83], p = 0.20) or prolonged antimicrobial therapy for more than 7 days (HR = 1.06, 95%CI [0.6; 1.86], p = 0.84). No differences were noted in in-hospital death irrespective of an appropriate and timely empiric antimicrobial therapy between mono- versus polymicrobial S. maltophilia HAP (p = 0.273). The duration of ventilation prior to S. maltophilia HAP diagnosis and ICU length of stay were shorter in patients with monomicrobial S. maltophilia HAP (p = 0.031 and p = 0.034 respectively).
Conclusions: S. maltophilia HAP occurred in severe, long-stay intensive care patients who mainly required prolonged invasive ventilation. Empirical antimicrobial therapy was barely effective while antimicrobial treatment modalities had no significant impact on hospital survival.
Trial Registration: clinicaltrials.gov, NCT03506191.
Databáze: MEDLINE
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