Treatment Outcomes of Stenotrophomonas maltophilia Bacteremia in Critically Ill Children
| Autor: | Yuval Geffen, Yossi Ben-Ari, Shalom Ben-Shimol, Itai M. Pessach, Marina Rubinstein, Gideon Paret, Gal Ben-Shalom, Itay Tokatly Latzer, Isaac Lazar, Yuval Cavari, Nathan Keller, Lior Goldberg, Elhanan Nahum |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Multivariate analysis Critical Illness Stenotrophomonas maltophilia Minocycline Comorbidity 030204 cardiovascular system & hematology Intensive Care Units Pediatric Critical Care and Intensive Care Medicine Trimethoprim Immunocompromised Host 03 medical and health sciences 0302 clinical medicine Ciprofloxacin Risk Factors Internal medicine Sulfadoxine medicine Humans Child Retrospective Studies biology Septic shock business.industry Infant 030208 emergency & critical care medicine Retrospective cohort study Odds ratio bacterial infections and mycoses medicine.disease biology.organism_classification Anti-Bacterial Agents Drug Combinations Child Preschool Bacteremia Pediatrics Perinatology and Child Health Female Gram-Negative Bacterial Infections business medicine.drug |
| Zdroj: | Pediatric Critical Care Medicine. 20:e231-e239 |
| ISSN: | 1529-7535 |
| DOI: | 10.1097/pcc.0000000000001919 |
| Popis: | OBJECTIVES Stenotrophomonas maltophilia is a gram-negative opportunistic bacterium that may cause a myriad of clinical diseases in immunocompromised individuals. We aimed to describe the clinical characteristics, risk factors, mortality, and treatment of S. maltophilia bacteremia in critically ill children, a topic on which data are sparse. DESIGN A multicenter observational retrospective study in which medical charts of critically ill children with S. maltophilia bacteremia were reviewed between 2012 and 2017. SETTING Data were collected from each of the four largest PICUs nationwide, allocated in tertiary medical centers to which children with complex conditions are referred regularly. PATIENTS A total of 68 suitable cases of S. maltophilia bacteremia were retrieved and reviewed. MEASUREMENTS AND MAIN RESULTS The total occurrence rate of S. maltophilia isolation had increased significantly during the study period (r = 0.65; p = 0.02). The crude mortality was 42%, and the attributed mortality was 18%. Significant risk factors for mortality were a longer length of hospital stay prior to infection (33 d in nonsurvivors vs 28 in survivors; p = 0.03), a nosocomial source of infection (p = 0.02), presentation with septic shock (p < 0.001), and treatment with chemotherapy (p = 0.007) or carbapenem antibiotics (p = 0.05) prior to culture retrieval. On multivariate analysis, septic shock (odds ratio, 14.6; 95% CI, 1.45-147.05; p = 0.023) and being treated with chemotherapy prior to infection (odds ratio, 5.2; 95% CI, 1.59-17.19; p = 0.006)] were associated with mortality. The combination of ciprofloxacin, trimethoprim-sulfamethoxazole, and minocycline resulted in the longest survival time (p < 0.01). CONCLUSIONS The significant attributed mortality associated with S. maltophilia bacteremia in critically ill children calls for an aggressive therapeutic approach. The findings of this investigation favor a combination of trimethoprim-sulfamethoxazole, ciprofloxacin, and minocycline. |
| Databáze: | OpenAIRE |
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