Clinical implications of stenotrophomonas maltophilia resistant to trimethoprim-sulfamethoxazole: a study of 69 patients at 2 university hospitals

Autor: Yehuda Carmeli, Didier Pittet, George M. Eliopoulos, Helen W. Boucher, Stéphan Juergen Harbarth, Sotirios Tsiodras
Jazyk: angličtina
Rok vydání: 2000
Předmět:
Microbiology (medical)
Male
medicine.medical_specialty
Cefotetan
Stenotrophomonas maltophilia
Intubation/adverse effects
Microbial Sensitivity Tests
Pharmacotherapy
Internal medicine
Drug Resistance
Multiple
Bacterial
Trimethoprim
Sulfamethoxazole Drug Combination
medicine
Hospitals/standards
Humans
Trimethoprim-Sulfamethoxazole Combination/ pharmacology/therapeutic use
Antibacterial agent
Retrospective Studies
ddc:616
Stenotrophomonas maltophilia/drug effects/pathogenicity
General Immunology and Microbiology
biology
business.industry
Sulfamethoxazole
Anti-Bacterial Agents/ pharmacology/therapeutic use
Trimethoprim Resistance
General Medicine
Middle Aged
biology.organism_classification
medicine.disease
Trimethoprim
Hospitals
Surgery
Anti-Bacterial Agents
Survival Rate
Pneumonia
Infectious Diseases
Ticarcillin
Gram-Negative Bacterial Infections/ drug therapy/microbiology/mortality
Female
Morbidity
business
Gram-Negative Bacterial Infections
Intubation
medicine.drug
Zdroj: Scandinavian Journal of Infectious Diseases, Vol. 32, No 6 (2000) pp. 651-656
ISSN: 0036-5548
Popis: We conducted a retrospective case study at 2 tertiary care centers to determine the clinical implications of trimethoprim-sulfamethoxazole resistant Stenotrophomonas maltophilia (TSRSM). Of 69 reviewed cases (mean age, 57 y; male gender, 70%), 40 (58%) were classified as infections associated with TSRSM (respiratory tract, 14; soft tissue, 11; bloodstream, 8; other sites, 7). Severe underlying comorbidities (86%) and previous antibiotic exposure (99%) were common. Cefotetan (susceptibility, 55%), chloramphenicol (49%) and ticarcillin-clavulanate (45%) showed the highest in vitro activity against TSRSM, but were seldom used for therapy (7%). Among the 40 infected cases, 8 developed sepsis disorders and 8 died. Only 1 death could be directly attributed to autopsy-proven TSRSM infection (pneumonia). McCabe score (p = 0.03) and organ dysfunction (p = 0.006) were associated with an increased risk of death in infected patients; exposure to appropriate therapy tended to be protective against death (p = 0.08). 22 infected patients were treated medically; an additional procedure was necessary to clear the infection in 18 cases (surgery, 13; catheter removal, 5). Isolation precautions were rarely exercised, even in the presence of panresistant isolates. In summary, TSRSM-related infections occurred in severely ill patients with extensive exposure to the health-care system, and often required invasive procedures for cure. Infections were directly associated with severe morbidity, and tended to have an indirect rather than a direct impact on mortality.
Databáze: OpenAIRE
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