Acute Crit Care.  2023 Nov;38(4):442-451. 10.4266/acc.2023.00682.

Risk factors for mortality in intensive care unit patients with Stenotrophomonas maltophilia pneumonia in South Korea

• Lee YH
• Lee J
• Yu B
• Lee WK
• Choi SH
• Park JE
• Seo H
• Yoo SS
• Lee SY
• Cha SI
• Kim CH
• Park JY

• KMID: 2550900
• DOI: http://doi.org/10.4266/acc.2023.00682

Abstract

Background
Stenotrophomonas maltophilia has been increasingly recognized as an opportunistic pathogen associated with high morbidity and mortality. Data on the prognostic factors associated with S. maltophilia pneumonia in patients admitted to intensive care unit (ICU) are lacking.
Methods
We conducted a retrospective analysis of data from 117 patients with S. maltophilia pneumonia admitted to the ICUs of two tertiary referral hospitals in South Korea between January 2011 and December 2022. To assess risk factors associated with in-hospital mortality, multivariable logistic regression analyses were performed.
Results
The median age of the study population was 71 years. Ventilator-associated pneumonia was 76.1% of cases, and the median length of ICU stay before the first isolation of S. maltophilia was 15 days. The overall in-hospital mortality rate was 82.1%, and factors independently associated with mortality were age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00–1.09; P=0.046), Sequential Organ Failure Assessment (SOFA) score (OR, 1.21; 95%; CI, 1.02–1.43; P=0.025), corticosteroid use (OR, 4.19; 95% CI, 1.26–13.91; P=0.019), and polymicrobial infection (OR, 95% CI 0.07–0.69). However, the impact of appropriate antibiotic therapy on mortality was insignificant. In a subgroup of patients who received appropriate antibiotic therapy (n=58), antibiotic treatment modality-related variables, including combination or empirical therapy, also showed no significant association with survival.
Conclusions
Patients with S. maltophilia pneumonia in ICU have high mortality rates. Older age, higher SOFA score, and corticosteroid use were independently associated with increased in-hospital mortality, whereas polymicrobial infection was associated with lower mortality. The effect of appropriate antibiotic therapy on prognosis was insignificant.

Keyword

antibiotic; intensive care units; pneumonia; risk factors

Figure

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  Figure 1. Flowchart of the study. ICU: intensive care unit.

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  Figure 2. (A) Antibiotic susceptibility of Stenotrophomonas maltophilia strains isolated from the respiratory tract specimen of critically ill patients (n=115). Susceptibility results for each antibiotic are expressed as a percentage of all cases. (B) Frequency distribution of coisolates in patients with polymicrobial infection (n=47). Results are sorted by frequency, with duplicates allowed. TMP–SMX: trimethoprim–sulfamethoxazole.

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