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1483. Pleural Empyema Caused by Stenotrophomonas maltophilia in a National Cohort of Hospitalized Veterans

BACKGROUND: S. maltophilia is an environmental multi-drug-resistant Gram-negative bacteria that is mostly found as a respiratory tract colonizer in patients with cystic fibrosis (CF) and as an opportunist in immunocompromised hosts. To understand the role of this pathogen in non-CF patients, we perf...

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Autores principales: Masroujeh, Ramy, Saade, Elie, Wilson, Brigid, Perez, Federico, Bonomo, Robert A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252944/
http://dx.doi.org/10.1093/ofid/ofy210.1312
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author Masroujeh, Ramy
Saade, Elie
Wilson, Brigid
Perez, Federico
Bonomo, Robert A
author_facet Masroujeh, Ramy
Saade, Elie
Wilson, Brigid
Perez, Federico
Bonomo, Robert A
author_sort Masroujeh, Ramy
collection PubMed
description BACKGROUND: S. maltophilia is an environmental multi-drug-resistant Gram-negative bacteria that is mostly found as a respiratory tract colonizer in patients with cystic fibrosis (CF) and as an opportunist in immunocompromised hosts. To understand the role of this pathogen in non-CF patients, we performed a retrospective analysis of hospitalized patients with S. maltophilia empyema in the Veterans Health Administration (VHA). METHODS: Using microbiology results within the VHA Corporate Data Warehouse, we identified pleural fluid cultures that tested positive for S. maltophilia among 1.9 million hospitalized patients between January 1, 2010 and December 31, 2017. We then reviewed the electronic health records for these patients and collected demographics, clinical characteristics, microbiology, antibiotic treatment, and outcome (30-day mortality). RESULTS: We identified 45 unique patients with S. maltophilia in pleural fluid cultures from 21 VHA facilities. Associated conditions included prolonged chest tube presence (n = 35), recent hospital admission (n = 34), recent antibiotic exposure (n = 30), cancer (n = 25), recent ICU stay (n = 23), and cardiothoracic surgery (n = 21). Most cultures were polymicrobial (n = 36), with the most commonly isolated organisms being Enterobacteriaceae (n = 12), Staphylococcus spp. (n = 11), and Pseudomonas aeruginosa (n = 9). According to susceptibility testing, trimethoprim-sulfamethoxazole (TMP-SMX) was the most active agent (93% susceptible), followed by levofloxacin (85%). Only 49% of tested isolates were susceptible to ceftazidime. In 27 (60%) of the cases, treatment directed against S. maltophilia was administered with TMP-SMX (n = 16), levofloxacin (n = 7) and minocycline (n = 4). In two cases, S. maltophilia was considered a contaminant since there was no evidence of pleural infection. In both groups, 30-day mortality was 22% (6/27 treated vs. 4/18 untreated). CONCLUSION: S. maltophilia is infrequently isolated from pleural fluid among patients in the VHA system and is commonly a polymicrobial infection following instrumentation or surgery. In this cohort, we observed a high mortality independent of treatment, likely reflecting host co-morbidities or ineffective treatments. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62529442018-11-28 1483. Pleural Empyema Caused by Stenotrophomonas maltophilia in a National Cohort of Hospitalized Veterans Masroujeh, Ramy Saade, Elie Wilson, Brigid Perez, Federico Bonomo, Robert A Open Forum Infect Dis Abstracts BACKGROUND: S. maltophilia is an environmental multi-drug-resistant Gram-negative bacteria that is mostly found as a respiratory tract colonizer in patients with cystic fibrosis (CF) and as an opportunist in immunocompromised hosts. To understand the role of this pathogen in non-CF patients, we performed a retrospective analysis of hospitalized patients with S. maltophilia empyema in the Veterans Health Administration (VHA). METHODS: Using microbiology results within the VHA Corporate Data Warehouse, we identified pleural fluid cultures that tested positive for S. maltophilia among 1.9 million hospitalized patients between January 1, 2010 and December 31, 2017. We then reviewed the electronic health records for these patients and collected demographics, clinical characteristics, microbiology, antibiotic treatment, and outcome (30-day mortality). RESULTS: We identified 45 unique patients with S. maltophilia in pleural fluid cultures from 21 VHA facilities. Associated conditions included prolonged chest tube presence (n = 35), recent hospital admission (n = 34), recent antibiotic exposure (n = 30), cancer (n = 25), recent ICU stay (n = 23), and cardiothoracic surgery (n = 21). Most cultures were polymicrobial (n = 36), with the most commonly isolated organisms being Enterobacteriaceae (n = 12), Staphylococcus spp. (n = 11), and Pseudomonas aeruginosa (n = 9). According to susceptibility testing, trimethoprim-sulfamethoxazole (TMP-SMX) was the most active agent (93% susceptible), followed by levofloxacin (85%). Only 49% of tested isolates were susceptible to ceftazidime. In 27 (60%) of the cases, treatment directed against S. maltophilia was administered with TMP-SMX (n = 16), levofloxacin (n = 7) and minocycline (n = 4). In two cases, S. maltophilia was considered a contaminant since there was no evidence of pleural infection. In both groups, 30-day mortality was 22% (6/27 treated vs. 4/18 untreated). CONCLUSION: S. maltophilia is infrequently isolated from pleural fluid among patients in the VHA system and is commonly a polymicrobial infection following instrumentation or surgery. In this cohort, we observed a high mortality independent of treatment, likely reflecting host co-morbidities or ineffective treatments. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6252944/ http://dx.doi.org/10.1093/ofid/ofy210.1312 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Masroujeh, Ramy
Saade, Elie
Wilson, Brigid
Perez, Federico
Bonomo, Robert A
1483. Pleural Empyema Caused by Stenotrophomonas maltophilia in a National Cohort of Hospitalized Veterans
title 1483. Pleural Empyema Caused by Stenotrophomonas maltophilia in a National Cohort of Hospitalized Veterans
title_full 1483. Pleural Empyema Caused by Stenotrophomonas maltophilia in a National Cohort of Hospitalized Veterans
title_fullStr 1483. Pleural Empyema Caused by Stenotrophomonas maltophilia in a National Cohort of Hospitalized Veterans
title_full_unstemmed 1483. Pleural Empyema Caused by Stenotrophomonas maltophilia in a National Cohort of Hospitalized Veterans
title_short 1483. Pleural Empyema Caused by Stenotrophomonas maltophilia in a National Cohort of Hospitalized Veterans
title_sort 1483. pleural empyema caused by stenotrophomonas maltophilia in a national cohort of hospitalized veterans
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252944/
http://dx.doi.org/10.1093/ofid/ofy210.1312
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