Stenotrophomonas matophilia bacteremia in elderly patients in the southern of vietnam: patient characteristic, antibiotics resistance and treatment outcome

Background: Stenotrophomonas maltophilia bacteremia in elderly patients represented high morbidity and mortality in critical ill and severely immune-compromised individuals. In these patients, poor prognosis is usually associated with advanced malignancies, increased use of invasive devices, prolonged mechanical ventilation and/or ICU stay, and long courses of broad-spectrum antibiotics. Antibiotic resistance rate is increasing, especially for trimethoprim-sulfamethoxazole and quinolones. Knowledge of local susceptibility patterns is helpful in determining which patients should receive appropriated empirical antibiotics against this pathogen. This study examined the data for S. maltophilia bacteremia in elderly patients, in an attempt to get better understanding of clinical characteristic and outcome.
Patients and method: A retrospective study was conducted at Thong Nhat hospital in the southern of Viet Nam. Patients who treated in the hospital with first positive blood culture between 1st January, 2018, and 31st December, 2019, were considered eligible for enrolment into this study. This investigation evaluated clinical characteristics, antibiotic resistances and outcome of patients as well as independent prognostic factors for mortality.
Results: Among 112 patients, average age was 77.4 ± 2, 0 years, 56.2% was male and SOFA score was 5.1 ± 4.2. Hypertension was common comorbid disease (59.8%). Nosocomial S. maltophilia bacteremia rate was 51.8%. Site of respiratory infection was 63.4%. The rate of septic shock accounted for 28.6%. Mortality rate of this population was high 30.4%. S.maltophilia was low resistant to TMP/SMX, moxifloxacin, levofloxacin, ciprofloxacin with the rate of 9.5%, 3.2%, 13.8%, 9.8%, respectively, as well as high resistant to meropenem (90.9%), imipenem (70%), gentamycin (88.8%), amikacin (75%). Multivariate analysis showed that the significant independent risk factors of mortality were SOFA score >7; mechanical ventilation and presentation with septic shock.
Conclusion: Stenotrophomonas maltophilia bacteremia is often severe in older patients. Mortality rate is still high and drug resistance is increasing. It is important to identify characteristic of antibiotic resistance to choose appropriate antibiotics as well as improve the patient’s severity.