Stenotrophomonas maltophilia (SM) is an important nosocomial pathogen. Due to its intrinsic resistance to various therapeutic drugs, the optimal antimicrobial
therapy is often delayed. From January 2005 to September 2012, we retrospectively compared
drug susceptibilities, clinical backgrounds, and outcome of SM bacteremic patients (SM group) with these of other non fermentative gram negative bacilli bacteremic patients (non-SM group), at a tertiary-care hospital in Kyoto, Japan. Among the SM group, risk factors of 30-day mortality were evaluated. The SM group and non-SM group included 54 and 237 cases, respectively. Among the non-SM group, bacteremic patients due to Pseudomonas aeruginosa, Acinetobacter species, and other non-fermentative gram negative bacilli included 156, 68, and 13 patients, respectively. SM isolates were susceptible to
trimethoprim-sulfamethoxazole and
minocycline (82.0% and 100%, respectively). Non-SM isolates were susceptible to
meropenem (88.6%),
ceftazidime (88.6%),
cefepime (85.2%), and
amikacin (97.0%). Both SM and non-SM isolates were susceptible to
levofloxacin (87.5% and 82.0%, respectively). The use of
carbapenems, antipseudomonal
cephalosporins, and isolation of SM within 30 days represented an independent risk factor for SM
bacteremia. The 30 day mortality rate among the SM group was significantly higher compared with the non-SM group (35% vs 18%, odds ratio: 2.2, 95% CI: 1.2-4.3 p = 0.012). Among the SM group, an independent factor which was associated with 30-day mortality was the SOFA score. SM
bacteremia showed a worse outcome compared with
bacteremia due to non-SM. For the patients who present risk factors for SM
bacteremia, empirical antimicrobial
therapy including
trimethoprim-sulfamethoxazole,
minocycline or
levofloxacin should be considered.