Background: There is little descriptive data on Stenotrophomonas maltophilia hospital-acquired pneumonia (HAP)\nin critically ill patients. The optimal modalities of antimicrobial therapy remain to be determined. Our objective was\nto describe the epidemiology and prognostic factors associated with S. maltophilia pneumonia, focusing on\nantimicrobial therapy.\nMethods: This nationwide retrospective study included all patients admitted to 25 French mixed intensive care\nunits between 2012 and 2017 with hospital-acquired S. maltophilia HAP during intensive care unit stay. Primary\nendpoint was time to in-hospital death. Secondary endpoints included microbiologic effectiveness and\nantimicrobial therapeutic modalities such as delay to appropriate antimicrobial treatment, mono versus\ncombination therapy, and duration of antimicrobial therapy.\nResults: Of the 282 patients included, 84% were intubated at S. maltophilia HAP diagnosis for duration of 11 [5â??18] days.\nThe Simplified Acute Physiology Score II was 47 [36â??63], and the in-hospital mortality was 49.7%. Underlying chronic\npulmonary comorbidities were present in 14.1% of cases. Empirical antimicrobial therapy was considered effective on S.\nmaltophilia according to susceptibility patterns in only 30% of cases. Delay to appropriate antimicrobial treatment had,\nhowever, no significant impact on the primary endpoint. Survival analysis did not show any benefit from combination\nantimicrobial therapy (HR = 1.27, 95%CI [0.88; 1.83], p = 0.20) or prolonged antimicrobial therapy for more than 7 days\n(HR = 1.06, 95%CI [0.6; 1.86], p = 0.84). No differences were noted in in-hospital death irrespective of an appropriate and\ntimely empiric antimicrobial therapy between mono- versus polymicrobial S. maltophilia HAP (p = 0.273). The duration of\nventilation prior to S. maltophilia HAP diagnosis and ICU length of stay were shorter in patients with monomicrobial S.\nmaltophilia HAP (p= 0.031 and p = 0.034 respectively).\nConclusions: S. maltophilia HAP occurred in severe, long-stay intensive care patients who mainly required prolonged\ninvasive ventilation. Empirical antimicrobial therapy was barely effective while antimicrobial treatment modalities had no\nsignificant impact on hospital survival.
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