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Answers linked to Garcia Paez JI, Costa SF. Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia: a systematic review. J Hosp Infect 2008;70:101–108.
Journal of Hospital Infection (2009) 71, 89e90
Available online at www.sciencedirect.com
www.elsevierhealth.com/journals/jhin
Continuing Professional Development and the Journal of Hospital Infection Answers linked to Garcia Paez JI, Costa SF. Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia: a systematic review. J Hosp Infect 2008;70:101e108. Available online 9 August 2008
1. What is the attributable mortality of bacteraemia due to S. maltophilia? (a) 40%. (b) 60%. (c) 27%. (d) 5%. Answer: (c). The only caseecontrol study that analysed attributable mortality of bacteraemia due to S. maltophilia showed a rate of 27%. 2. What are the risk factors associated with mortality due to S. maltophilia in multivariate analysis studies? (a) APACHE II score >15. (b) Inadequate antimicrobial therapy. (c) Sepsis and neutropenia. (d) Acute leukaemia. Answer: (a). In the four studies using multivariate analysis, variables related to the initial
clinical conditions were the more relevant. Shock, thrombocytopenia, APACHE II score >15 and number of dysfunctional organs. 3. Choose the correct statement: (a) By multivariate analysis the only statistically significant risk factor associated with acquisition of infection due to trimethoprimsulfamethoxazole-resistant S. maltophilia was the exposure to appropriate therapy. (b) Thrombocytopenia and shock were independent risk factors for death due bacteraemia caused by S. maltophilia. (c) SOFA score <6 was a risk factor significantly associated with mortality in patients with infection due to S. maltophilia. (d) Multivariate analysis showed that only initial discordant antimicrobial therapy was an independent risk factor associated with mortality of cancer patients with pneumonia caused by S. maltophilia.
Summarizing the instructions from the Royal College of Pathologists: (1) One CPD point is allowed for each question and answer set (up to five questions and answers). (2) Answers must be recorded referenced back to the questions and recorded in the CPD portfolio. (3) It is essential that participants include the completed response form showing both questions and answers in their portfolio as these may be subject to audit by RCPath. For further information about the Royal College of Pathologists’ CPD scheme and credit allocation, please contact: Professional Standards Unit, CPD Section, Royal College of Pathologists, 2 Carlton House Terrace, London, SW1Y 5AF, UK. E-mail: [email protected] or visit http://www.rcpath.org 0195-6701/$ - see front matter ª 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2008.06.003
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Continuing Professional Development and the Journal of Hospital Infection Answer: (b). Lai et al. evaluated 84 episodes of bacteraemia caused by S. maltophilia and showed, using multivariate analysis, that thrombocytopenia and shock were independent risk factors for death.
4. Choose the correct statement: (a) Data were insufficient to confirm that appropriate antimicrobial therapy reduces mortality rates of infection due to S. maltophilia because of the characteristics of studies published in the literature.
(b) S. maltophilia was the second most frequent non-fermentative Gram-negative reported in the SENTRY Antimicrobial Surveillance Program 1997e2001. (c) In uncontrolled clinical trials, crude mortality rates associated with S. maltophilia infections ranged from 5 to 99%. (d) In cancer patients mucositis and acute leukaemia are independent risk factors associated with mortality due to S. maltophilia infections. Answer: (a).
Available online at www.sciencedirect.com
www.elsevierhealth.com/journals/jhin
Continuing Professional Development and the Journal of Hospital Infection Answers linked to Garcia Paez JI, Costa SF. Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia: a systematic review. J Hosp Infect 2008;70:101e108. Available online 9 August 2008
1. What is the attributable mortality of bacteraemia due to S. maltophilia? (a) 40%. (b) 60%. (c) 27%. (d) 5%. Answer: (c). The only caseecontrol study that analysed attributable mortality of bacteraemia due to S. maltophilia showed a rate of 27%. 2. What are the risk factors associated with mortality due to S. maltophilia in multivariate analysis studies? (a) APACHE II score >15. (b) Inadequate antimicrobial therapy. (c) Sepsis and neutropenia. (d) Acute leukaemia. Answer: (a). In the four studies using multivariate analysis, variables related to the initial
clinical conditions were the more relevant. Shock, thrombocytopenia, APACHE II score >15 and number of dysfunctional organs. 3. Choose the correct statement: (a) By multivariate analysis the only statistically significant risk factor associated with acquisition of infection due to trimethoprimsulfamethoxazole-resistant S. maltophilia was the exposure to appropriate therapy. (b) Thrombocytopenia and shock were independent risk factors for death due bacteraemia caused by S. maltophilia. (c) SOFA score <6 was a risk factor significantly associated with mortality in patients with infection due to S. maltophilia. (d) Multivariate analysis showed that only initial discordant antimicrobial therapy was an independent risk factor associated with mortality of cancer patients with pneumonia caused by S. maltophilia.
Summarizing the instructions from the Royal College of Pathologists: (1) One CPD point is allowed for each question and answer set (up to five questions and answers). (2) Answers must be recorded referenced back to the questions and recorded in the CPD portfolio. (3) It is essential that participants include the completed response form showing both questions and answers in their portfolio as these may be subject to audit by RCPath. For further information about the Royal College of Pathologists’ CPD scheme and credit allocation, please contact: Professional Standards Unit, CPD Section, Royal College of Pathologists, 2 Carlton House Terrace, London, SW1Y 5AF, UK. E-mail: [email protected] or visit http://www.rcpath.org 0195-6701/$ - see front matter ª 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2008.06.003
90
Continuing Professional Development and the Journal of Hospital Infection Answer: (b). Lai et al. evaluated 84 episodes of bacteraemia caused by S. maltophilia and showed, using multivariate analysis, that thrombocytopenia and shock were independent risk factors for death.
4. Choose the correct statement: (a) Data were insufficient to confirm that appropriate antimicrobial therapy reduces mortality rates of infection due to S. maltophilia because of the characteristics of studies published in the literature.
(b) S. maltophilia was the second most frequent non-fermentative Gram-negative reported in the SENTRY Antimicrobial Surveillance Program 1997e2001. (c) In uncontrolled clinical trials, crude mortality rates associated with S. maltophilia infections ranged from 5 to 99%. (d) In cancer patients mucositis and acute leukaemia are independent risk factors associated with mortality due to S. maltophilia infections. Answer: (a).