400. Impact of Combination Therapy and Predictors of Mortality in Patients with Stenotrophomonas maltophilia Bacteremia
Session: Poster Abstract Session: Gram Negative Infection - Epidemiology and Prevention
Friday, October 21, 2011
Room: Poster Hall B1

Background: Stenotrophomonas maltophilia has emerged as an important nosocomial pathogen in the immunocompromised host, causing infections whose management is often difficult due to its inherent resistance to many antibiotics. Regarding to the previous in vitro studies, combination therapy has been suggested for severe S. maltophilia infection. However, there is no clinical data about the role of combination therapy. This study was performed to investigate the impact of combination therapy, and predictors of mortality in patients with S. maltophilia bacteremia.

Methods: We retrospectively reviewed 150 episodes of S. maltophilia bacteremia from July 2006 to January 2011 at the 2,700-bed university-affiliated tertiary care hospital in Korea. After excluding 29 episodes with inadequate therapy, 121 episodes were finally enrolled for analysis. We compared the clinical characteristics and outcomes between monotherapy group and combination therapy group.

Results: Eighty nine episodes (73.6%) were treated with monotherapy and 32 episodes (26.4%) were treated with combination therapy. Baseline demographic and clinical characteristics were similar. Malignancy was the most common underlying disease (75.3% [67/89] vs. 84.4%[27/32], P = 0.29). No significant differences between two groups were noted in microbiologic response (68.5% [61/89] vs 71.9% [23/32], P = 0.72), bacteremia-related mortality (12.4% [11/89] vs. 9.4% [3/32], P =0.758), 30-day mortality (9.9% [7/89] vs. 14.3% [3/32], P = 0.69), and crude mortality (31.8% [27/89] vs. 37.5% [12/32], P =0.56). Independent predictors of 30-day mortality of S. maltophilia bacteremia in logistic regression included the chronic renal failure (adjusted odds ratio [AOR], 16.8, CI 3.11-90.23, P = 0.001), pneumonia (AOR, 10.0, CI, 1.25-79.75, P = 0.03), Pitt bacteremia score (AOR, 1.45, CI, 1.06-2.00, P = 0.02), and Charlson co-mobidity score (AOR, 1.33, 95% CI, 1.01-1.77, P = 0.046).

Conclusion: Combination therapy for S. maltophilia bacteremia was not associated with better outcome. Chronic renal failure, pneumonia, severe initial manifestation, and underlying comorbidity were significant predictors for mortality.

 


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Yumi Lee, MD, Gwang Beom Go, M.D., Hyun Jung Park, MD, So-Youn Park, MD, Song Mi Moon, MD, Ki-Ho Park, MD, Yong Pil Chong, MD, Sung-Han Kim, MD, PhD, Sang-Oh Lee, MD, Yang-Soo Kim, MD, June Hee Woo, MD and Sang-Ho Choi, MD, PhD, Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Disclosures:

Y. Lee, None

G. B. Go, None

H. J. Park, None

S. Y. Park, None

S. M. Moon, None

K. H. Park, None

Y. P. Chong, None

S. H. Kim, None

S. O. Lee, None

Y. S. Kim, None

J. H. Woo, None

S. H. Choi, None

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