To describe some clinical and subclinical characteristics in patients with sepsis caused by S. maltophilia and identify antibiotic resistance status in S. maltophilia strain was isolated.
Trang 1RESEARCH ON CLINICAL AND SUBCLINICAL
CHARACTERISTICS IN PATIENTS WITH SEPSIS CAUSED BY
STENOTROPHOMONAS MALTOPHILIA TREATED AT
103 MILITARY HOSPITAL AND 108 MILITARY CENTRAL HOSPITAL
(FROM JANUARY 2014 TO OCTOBER 2018)
Nguyen Hoang Thanh 1 ; Hoang Vu Hung 1
SUMMARY
Objectives: To describe some clinical and subclinical characteristics in patients with sepsis
caused by S maltophilia and identify antibiotic resistance status in S maltophilia strain was
isolated Subjects and methods: Retrospective combined prospective, descriptive cases in
63 patients with sepsis caused by S maltophilia treated at 103 Military Hospital and 108 Central
Military Hospital Results: 61.9% of patients > 60 years old; men: 77.8%; 85.7% pathological
background; 76.2% identified the primary infection source; 99.4% fever in which suddenly of
fever 51.6%, fluctuating of fever 64.5%, hot fever 41.9% Sepsis caused by S maltophilia
damaged most organs: 42.9% consciousness disorders; heart rate > 90 cycles/minute: 60.4%;
hypotension: 11.1%; pneumonia: 71.2%; abdominal pain: 18.8%; painful urination: 5.9%;
WBC > 10 G/L: 67.7%; hemoglobin < 120 g/L: 68.4%; platelets < 150 GLl: 19.3%; urea > 7.5 mmol/L:
23.5%; ALT > 80 U/L: 11.8%; 22.7% of patients had total bilirubine > 17 µmol/L; 17.5% of
patients had prothrombine ratio < 70%; 22% of patients had PCT > 10 ng/mL S maltophilia
strain isolated were resistant to cefotaxime: 95.7%, ceftriaxone: 95%; imipenem: 100%,
meropenem: 100%; ampicillin resistance: 100%; aminoglycosid antibiotics resistance: 70 - 80%
Mortality rate was 17/63 patients (27%) Conclusion: Sepsis caused by S maltophilia was
common in elderly people; the mortality rate was relatively high S maltophilia strain isolated
was multi antibiotic resistance
* Keywords: Sepsis; Stenotrophomonas maltophilia; Clinical and subclinical characteristics
INTRODUCTION
Sepsis caused by S maltophilia is rare,
mainly diagnosed in patients with cancer,
lung cystic fibrosis, immunodeficiency
103 Military Hospital and 108 Military
Central Hospital are equipped with
modern equipment such as Batec blood
culture system, identifier and antimicrobial
Vitek automatic… This has contributed
positively to the diagnosis of rare
pathogens, including S maltophilia In
order to contribute to the diagnosis and timely treatment, selecting appropriate antibiotics, shortening hospital time, reducing costs for patients and reduce mortality rate in patients with sepsis
caused by S maltophilia, we carried out
this thesis with aims:
1 103 Military Hospital
Corresponding author: Nguyen Hoang Thanh (hoangthanh27081991hvqy@gmail.com)
Date received: 25/09/2019
Date accepted: 19/11/2019
Trang 2- Survey the number of characteristics
in clinical, subclinical in patients with
sepsis caused by S maltophilia
- Determination of antibiotic resistance
of isolated S maltophilia strains
SUBJECTS AND METHODS
1 Subjects
63 patients with sepsis caused by
S maltophilia: 40 patients were hospitalized
and treated at 103 Military Hospital and
23 patients were hospitalized and treated
at 108 Military Central Hospital from January
2014 to November 2018
* Criteria for selecting patients:
Patients were diagnosed with sepsis
based on consent of the International
Conference on Sepsis (2001) [6]:
- Having systemic inflammatory response
syndrome: At least 2 of the following 4
criteria (including a compulsory standard
for abnormalities in body temperature or
white blood cell counts)
+ Body temperature > 38ºC or < 36ºC
+ Heart rate > 90 cycles/minute
+ Frequency of breathing > 20 cycles/minute
or PaCO2 < 32 mmHg
+ White blood cell counts > 12,000 or
< 4,000/mm3, or young white blood cell
count > 10%
- Blood cultures were isolated S maltophilia
bacteria
- Patients over 18 years of age
* Exclusion criteria:
- The patient refused to participate in
the study
- The patient had a positive blood
culture (+) with at least ≥ 2 pathogens
2 Methods.
Cross-sectional combined with retrospective and prospective study for enough qualifies cases
- Retrospective cases of sepsis caused
by S maltophilia infection hospitalized and
treated between 01 - 2014 and 10 - 2017 (55 patients)
- Prospective cases of sepsis caused
by S maltophilia infection hospitalized and
treated between 11 - 2017 and 11 - 2018 (08 patients)
Data collection through the store of medical records, all medical records were registered under unified form
* Research content:
- Distribution of patients according to age, gender, source of infection (hospital infections and community infections), pathological background, primary infections source
- Shock and mortality rate
- Clinical symptoms: Characteristics and properties of fever; skin and mucosa manifestations; consciousness disorder; damage to the circulatory system (pulse, blood pressure ); damage to the respiratory system (pneumonia, pleural effusion, respiratory failure ); damage to the digestive system (digestive disorders, hepatomegaly, splenomegaly, abdominal pain, jaundice ); damage to the urinary system (painful urination, oliguria, anuria )
- Learn about the clinical indicators: Number of red blood cells (T/L), hemoglobine (g/L); leukocyte count (G/L), percentage of neutrophil; platelets (G/L); prothrombine rate (%); enzymes AST,
Trang 3ALT (U/L); total bilirubine (µmol/L); blood
urea (mmol/L); blood creatinine (µmol/L);
electrolytes; procalcitonine (ng/mL)
- Determine antibiotic resistance according
to technical antimicrobial were performed
automatically on the system identification Vitek 2 - BIOMÉRIEUX or performed by Kirby - Bauer technique
The results collected were processed using SPSS software version 23.0
RESULTS
Table 1: Epidemiological characteristics of patients
Pathological
background
Primary
infections
The group over 60 years old accounted for the largest proportion (61.9%) The proportion
of male was 3.5 times higher than women
Table 2: The clinical symptoms
Fever
Suddenly of fever and fluctuating of fever were occured in more than 50% of patients
Trang 4Table 3: Subclinical characteristics
Subclinical index patients No Rate (%) Subclinical index patients No Rate (%)
Table 4: Antibiotic resistance of S maltophilia strain were isolated
Trang 5- Bacteria were highly sensitive with
trimethoprim/sulfamethoxazole antibiotics
(90.9%); antibiotics of cycline group:
minocyclin (100%), doxycycllin (81.8%);
colistin (80.0%); levofloxacin (87.8%)
- S maltophilia most resistant to
cephalosporin antibiotics: Cefotaxime
(95.7%), ceftriaxone (95.0%); carbapenem
antibiotics: imipenem (100%), meropenem
(100%), ertapenem (88.2); aminoglycoside
antibiotics: gentamycin (71.4%), tobramycin
(70.0%), amikacin (80.0%)
DISCUSSION
In recent decades, sepsis caused by
S maltophilia was a medical problem that
needs attention due to the increasing
incidence of morbidity and mortality
According to the study by Chung-Hsu Lai
(2004), 84 sepsis patients caused by S
maltophilia had an average age of 62.3 ±
2.0 years old; male 75%; hospital sepsis
76%; primary infection from respiratory
tract 33% and intravascular catheter 31%;
septic shock 48%; mortality rate of 33%;
antimicrobial results of S maltophilia
strains were isolated 100% resistant to
imipenem; some antibiotics susceptible
including ciprofloxacin 39/47 (83.0%);
trimethoprim/sulfamethoxazole 64/84
(76.0%); these results were similar to
our study [4]
Xi Chen, Wenjun Wu et al (2017)
studied retrospectively 95 sepsis patients
caused by S maltophilia in 6 years (2009 -
2015) at Zhejiang University (China)
Results: The mortality rate was higher than
our study (37.9%); common background
diseases were diabetes and blood cancer
with the same rate (19%), COPD (13.7%)
and chronic kidney failure (6.3%); 93.7%
of patients with fever was higher than 38ºC, the average temperature was 39.2ºC;
proportion of patients with leukocytosis was 29.5%; CRP concentration > 10 mg/L
accounted for 88.4%; S maltophilia strains
resistance to gentamycin (87.6%), amikacin (85.6%), and imipenem (97.8%) [9]
Mustafa Gokhan Gozel (2015) studied
at Turkey's Cumhuriyet Hospital on
35 patients with sepsis caused by
S maltophilia, the average age of patients
was 61.9 ± 18; proportion of male infected was 22/35 (62.9%); pathological background was similar to our research included:
chronic obstructive bronchitis (37.1%), diabetes (31.4%), cancer (28.6%), heart failure (17.1%), chronic renal failure (11.4%);
the proportion of patients with anemia (82.9%); 40% of patients increased the number of white blood cells; 37.1% of patients with reduced platelet count;
85.7% of patients increased CRP levels [7]
According to research by Ya-Ting Chang (2012), 94 patients sepsis caused
by S maltophilia had common pathological
background included: cancer (41.5%), diabetes (33.0%), chronic kidney failure 25/94 (26.6%), chronic obstructive broncho- pulmonary disease (8.5%); 61.4% of patients with hospital infections; primary infection detecting from intravascular catheter (20.2%), respiratory tract (14.9%), gastrointestinal tract (7.4%); bacteria sensitive to the antibiotic TMP/SMX (68.9%), levofloxacin (89.9%), minocycline (99.4%) [10] Research by Hirotaka Ebara (2015):
average age of 44 patients with sepsis
caused by S maltophilia was 48.9; male
63.6%; 4.5% of patients had damaged
Trang 6skin and soft tissue; primary infection
from intravascular catheter 36.4%,
gastrointestinal tract 11.4%, respiratory
tract 4.5%, unknown infection source
43.2%; mortality proportion 38.9% [5]
Sumida et al (2015) studied 30 sepsis
patients caused by S maltophilia with an
average age of 51; the proportion of male
patients were 1.5 times higher than
female; septic shock 20% [8]
Recent domestic studies also reported
S maltophilia bacteria as an emerging
cause of sepsis Research by Tran Van Si
et al (2013) at Kiengiang General Hospital
found that sepsis caused by S maltophilia
accounted for 1.7% [2] Tran Thi Thanh Nga
studied 8,665 strains of bacteria isolated
from sepsis patients at Cho Ray Hospital
for 5 years showed that S maltophilia
tend to increase in 2011 and 2012, 5.7%
and 13.7%, respectively compared with
2009 was only 1% [1] The study by
Le Xuan Truong (2009): 6/79 sepsis
patients (7.6%) caused by S maltophilia
had average PCT value of 36.2 ng/mL [3]
CONCLUSION
Sepsis caused by S maltophilia was
common in elderly people (61.9%); 85.7%
of patients had pathological background;
76.2% identified the primary infection
(in which primary infection was common
in respiratory tract 47.6%); fever 99.4%
(in which suddenly fever 51.6%, fluctuating
fever 64.5%, hot fever 41.9%) Sepsis
caused by S maltophilia damaged most
organs: 42.9% consciousness disorders;
heart rate > 90 cycles/minute 60.4%;
hypotension 11.1%; pneumonia 71.2%;
abdominal pain 18.8%; painful urination
5.9%; white blood cells > 10 G/L (67.7%);
Hb < 120 g/L (68.4%); platelets < 150 G/L (19.3%); ure > 7.5 mmol/L (23.5%); ALT > 80 U/L (11.8%); 22.7% of patients had total bilirubine > 17 µmol/L; 17.5% of patients had prothrombine rate < 70%; 22% patients with PCT > 10 ng/mL There were 17.5% of patients manifested septic shock; 27% mortality
Strains of S maltophilia isolated multiple
antibiotic resistance included: Cephalosporin antibiotic group: cefotaxime 95.7%, ceftriaxone 95%; carbapenem antibiotic group: imipenem 100%, meropenem 100%; 100% ampicillin resistance; aminoglycoside
resistance 70 - 80%
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