Assessment of the relative benefits of monotherapy and combination therapy approaches to the treatment of hospital-acquired Stenotrophomonas maltophilia pneumonia: a multicenter, observational, real-world study

Annals of Intensive Care

Research

Xuanyu Luo¹  Yihong Zhu¹  Le Le¹  Ziqi Wang¹  Xiaoli Sun¹  Chenyang Yuan¹  Shujie Hong¹  Ruochen Jing¹  Jie Hua²  Xiaopu He³  Liang Chen⁴ 

[1] Department of Clinical Medicine, Nanjing Medical University, Nanjing, China;Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China;Department of Geriatric Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, 210029, Nanjing, China;Department of Infectious Diseases, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China;

关键词: S. maltophilia;    Hospital-acquired pneumonia;    Efficacy;    Monotherapy;    Combination therapy;   

DOI  :  10.1186/s13613-023-01144-7

 received in 2023-03-10, accepted in 2023-05-25,  发布年份 2023

来源: Springer

【 摘 要 】

PurposeStenotrophomonas maltophilia is a Gram-negative pathogen that most commonly causes hospital-acquired infections that can be extremely challenging to treat, contributing to underrecognized mortality throughout the world. The relative benefits of monotherapy as compared to combination therapy in patients diagnosed with S. maltophilia pneumonia, however, have yet to be established.MethodsData from 307 patients diagnosed with S. maltophilia hospital-acquired pneumonia (HAP) across four Chinese teaching hospitals from 2016 to 2022 were retrospectively analyzed.ResultsOf the analyzed patients, 55.7% (171/307) were administered combination definitive therapy, with a 30-day all-cause mortality rate of 41.0% (126/307). A propensity score weighting analysis revealed that compared with monotherapy, combination definitive therapy was associated with a comparable 30-day mortality risk in the overall patient cohort (OR 1.124, 95% CI 0.707–1.786, P = 0.622), immunocompetent patients (OR 1.349, 95% CI 0.712–2.554, P = 0.359), and patients with APACHE II scores < 15 (OR 2.357, 95% CI 0.820–6.677, P = 0.111), whereas it was associated with a decreased risk of death in immunocompromised patients (OR 0.404, 95% CI .170–0.962, P = 0.041) and individuals with APACHE II scores ≥ 15 (OR 0.494, 95% CI 0.256–0.951, P = 0.035).ConclusionThe present data suggest that when treating S. maltophilia-HAP, immunocompromised patients and individuals with APACHE II scores ≥ 15 may potentially benefit from combination therapy.

【 授权许可】

CC BY   
© The Author(s) 2023

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