Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia

Abstract Background Ventilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia is poorly described in the literature. However, it has been shown to be associated with increased morbidity and mortality. Probabilistic antibiotic therapy against S. maltophilia is often ineffective as...

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Autores principales:	Bérénice Puech, Clémence Canivet, Laura Teysseyre, Guillaume Miltgen, Thomas Aujoulat, Margot Caron, Chloé Combe, Julien Jabot, Olivier Martinet, Jerome Allyn, Cyril Ferdynus, Nicolas Allou
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Ventilator-associated pneumonia Stenotrophomonas maltophilia Outcome Antibiotic therapy Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/1f23abaae9c74f6b8629afbb60908c52
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spelling	oai:doaj.org-article:1f23abaae9c74f6b8629afbb60908c522021-11-28T12:03:36ZEffect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia10.1186/s13613-021-00950-12110-5820https://doaj.org/article/1f23abaae9c74f6b8629afbb60908c522021-11-01T00:00:00Zhttps://doi.org/10.1186/s13613-021-00950-1https://doaj.org/toc/2110-5820Abstract Background Ventilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia is poorly described in the literature. However, it has been shown to be associated with increased morbidity and mortality. Probabilistic antibiotic therapy against S. maltophilia is often ineffective as this pathogen is resistant to many antibiotics. There is no consensus at present on the best therapeutic strategy to adopt (class of antibiotics, antibiotic combination, dosage, treatment duration). The aim of this study was to evaluate the effect of antibiotic therapy strategy on the prognosis of patients with VAP caused by S. maltophilia. Results This retrospective study evaluated all consecutive patients who developed VAP caused by S. maltophilia between 2010 and 2018 while hospitalized in the intensive care unit (ICU) of a French university hospital in Reunion Island, in the Indian Ocean region. A total of 130 patients with a median Simplified Acute Physiology Score II of 58 [43–73] had VAP caused by S. maltophilia after a median duration of mechanical ventilation of 12 [5–18] days. Ventilator-associated pneumonia was polymicrobial in 44.6% of cases, and ICU mortality was 50.0%. After multivariate Cox regression analysis, the factors associated with increased ICU mortality were older age (hazard ratio (HR): 1.03; 95% CI 1.01–1.04, p = 0.001) and high Sequential Organ Failure Assessment score on the day of VAP onset (HR: 1.08; 95% CI 1.03–1.14, p = 0.002). Appropriate antibiotic therapy, and in particular trimethoprim–sulfamethoxazole, was associated with decreased ICU mortality (HR: 0.42; 95% CI 0.24–0.74, p = 0.003) and decreased hospital mortality (HR: 0.47; 95% CI 0.28–0.79, p = 0.04). Time to start of appropriate antibiotic therapy, combination therapy, and duration of appropriate antibiotic therapy had no effect on ICU mortality (p > 0.5). Conclusion In our study, appropriate antibiotic therapy, and in particular trimethoprim–sulfamethoxazole, was associated with decreased ICU and hospital mortality in patients with VAP caused by S. maltophilia.Bérénice PuechClémence CanivetLaura TeysseyreGuillaume MiltgenThomas AujoulatMargot CaronChloé CombeJulien JabotOlivier MartinetJerome AllynCyril FerdynusNicolas AllouSpringerOpenarticleVentilator-associated pneumoniaStenotrophomonas maltophiliaOutcomeAntibiotic therapyMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENAnnals of Intensive Care, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ventilator-associated pneumonia Stenotrophomonas maltophilia Outcome Antibiotic therapy Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Ventilator-associated pneumonia Stenotrophomonas maltophilia Outcome Antibiotic therapy Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Bérénice Puech Clémence Canivet Laura Teysseyre Guillaume Miltgen Thomas Aujoulat Margot Caron Chloé Combe Julien Jabot Olivier Martinet Jerome Allyn Cyril Ferdynus Nicolas Allou Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia
description	Abstract Background Ventilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia is poorly described in the literature. However, it has been shown to be associated with increased morbidity and mortality. Probabilistic antibiotic therapy against S. maltophilia is often ineffective as this pathogen is resistant to many antibiotics. There is no consensus at present on the best therapeutic strategy to adopt (class of antibiotics, antibiotic combination, dosage, treatment duration). The aim of this study was to evaluate the effect of antibiotic therapy strategy on the prognosis of patients with VAP caused by S. maltophilia. Results This retrospective study evaluated all consecutive patients who developed VAP caused by S. maltophilia between 2010 and 2018 while hospitalized in the intensive care unit (ICU) of a French university hospital in Reunion Island, in the Indian Ocean region. A total of 130 patients with a median Simplified Acute Physiology Score II of 58 [43–73] had VAP caused by S. maltophilia after a median duration of mechanical ventilation of 12 [5–18] days. Ventilator-associated pneumonia was polymicrobial in 44.6% of cases, and ICU mortality was 50.0%. After multivariate Cox regression analysis, the factors associated with increased ICU mortality were older age (hazard ratio (HR): 1.03; 95% CI 1.01–1.04, p = 0.001) and high Sequential Organ Failure Assessment score on the day of VAP onset (HR: 1.08; 95% CI 1.03–1.14, p = 0.002). Appropriate antibiotic therapy, and in particular trimethoprim–sulfamethoxazole, was associated with decreased ICU mortality (HR: 0.42; 95% CI 0.24–0.74, p = 0.003) and decreased hospital mortality (HR: 0.47; 95% CI 0.28–0.79, p = 0.04). Time to start of appropriate antibiotic therapy, combination therapy, and duration of appropriate antibiotic therapy had no effect on ICU mortality (p > 0.5). Conclusion In our study, appropriate antibiotic therapy, and in particular trimethoprim–sulfamethoxazole, was associated with decreased ICU and hospital mortality in patients with VAP caused by S. maltophilia.
format	article
author	Bérénice Puech Clémence Canivet Laura Teysseyre Guillaume Miltgen Thomas Aujoulat Margot Caron Chloé Combe Julien Jabot Olivier Martinet Jerome Allyn Cyril Ferdynus Nicolas Allou
author_facet	Bérénice Puech Clémence Canivet Laura Teysseyre Guillaume Miltgen Thomas Aujoulat Margot Caron Chloé Combe Julien Jabot Olivier Martinet Jerome Allyn Cyril Ferdynus Nicolas Allou
author_sort	Bérénice Puech
title	Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia
title_short	Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia
title_full	Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia
title_fullStr	Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia
title_full_unstemmed	Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia
title_sort	effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by stenotrophomonas maltophilia
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/1f23abaae9c74f6b8629afbb60908c52
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Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia

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