Risk factors associated with isolation of Stenotrophomonas (Xanthomonas) maltophilia in clinical specimens.

ABSTRACT

OBJECTIVE: To determine risk factors for patients whose cultures grew Stenotrophomonas maltophilia. DESIGN: Retrospective case-control study of 60 patients with cultures positive for S maltophilia, matched by specimen site to 120 controls whose cultures grew other gram-negative aerobic bacteria. SETTING: University medical center. RESULTS: S maltophilia was identified from the following sites respiratory (36), wound (13), urinary (6), blood (4), and cerebral spinal fluid (1). By univariate analysis, cases had a higher risk of exposure than controls for ampicillin (P < .001), gentamicin (P < .001), vancomycin (P = .001), metronidazole (P = .003), piperacillin (P = .007), cefotaxime (P = .014), ceftazidime (P = .017), ciprofloxacin (P = .030), tobramycin (P = .040), and chronic respiratory disease (P = .024). Length of time foreign objects were in place prior to positive culture differed significantly between cases and controls only for endotracheal tubes in patients with respiratory isolates (median number of days 12.5 for cases, 5 for controls; P = .007). For patients with urinary tract infections, having a urinary catheter increased the odds of infection 10 times over controls. Exposures found by multivariate analysis to be significantly more prevalent in cases than controls included ampicillin, cefotaxime, erythromycin, gentamicin, metronidazole, piperacillin, tobramycin, chronic respiratory disease, and female gender. Odds ratios were > 1 indicating higher risk for cases, except for erythromycin, which had an odds ratio < 1. CONCLUSIONS: The primary risk factor associated with isolation of S maltophilia was antibiotic use. For patients with pulmonary infections, chronic respiratory disease and length of time an endotracheal tube was in place also contributed to the risk. This suggests that judicious use of antibiotics may prevent some cases of S maltophilia infection.