SESSION TITLE: ICU Infections
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 27, 2013 at 10:45 AM - 11:45 AM
PURPOSE: To determine the epidemiology of Stenotrophomonas maltophilia bacteremia in an ICU. We hypothesized increased in-hospital mortality and morbidity correlated with retained central venous catheter.
METHODS: This is a retrospective cohort study of adult patients with S.maltophilia bacteremia hospitalized in an ICU at a tertiary academic hospital between the dates January 2001 through September of 2012.
RESULTS: Twenty six ICU patients (42% medical, 58% surgical) developed S.maltophilia bacteremia, (50% male; mean age, 61.4 ± 15.9 years; mean length of hospital stay, 77.9 ± 98 days). 84% (n=21) were mechanically ventilated. 73% (n=19) had a prior surgery performed within ninety days of positive blood culture. 69% (n=18) had a positive culture of S.maltophilia from another site, most commonly from sputum (n=17). 42% (n=11) had concurrent polymicrobial bloodborne infections. All patients were exposed to antibiotics in the preceding ninety days (73% to antifungal agent, 58% to cephalosporins, 54% to penicillins, 46% to carbapenems, 46% to quinolones). All patients had a central catheter at the time of positive culture, with subsequent removal in 73% (n=19). All cause in-hospital mortality was 27% (n=7). We found an association of higher mortality with those who did not have central line removal compared with those who did (p-value <0.02).
CONCLUSIONS: This study shows significant mortality associated with S.maltophilia bacteremia and ICU hospitalization. Medical interventions common in the ICU setting including antibiotics, central catheter and mechanical ventilation were identified as risk factors for S. maltophilia bacteremia. Delays in starting effective antimicrobial therapy and retention of infected central lines may contribute to overall mortality.
CLINICAL IMPLICATIONS: Due to the significant mortality and morbidity, this study suggests early consideration for S.maltophilia infections in the ICU, especially in patients who are intubated, are receiving antimicrobial therapy, and have a central catheter. This is the first study to show association of non-removal of central line in S.maltophilia bacteremia with increased mortality in the ICU, and should be strongly considered as part of the treatment. Prospective study will need to be validated.
DISCLOSURE: The following authors have nothing to disclose: Sarah Lee, Kelly Cawcutt, Nathan Smischney, Lynn Estes, John Wilson
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