Microbial Issues

Stenotrophomonas maltophilia infection in hematopoietic SCT recipients: high mortality due to pulmonary hemorrhage

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Abstract

To clarify the clinical features and outcome of Stenotrophomonas maltophilia infection among hematopoietic SCT (HCT) recipients, we retrospectively reviewed the records of 1085 consecutive HCT recipients and identified 42 episodes in 31 HCT recipients with S. maltophilia infection. We compared these recipients with 30 non-HCT patients with S. maltophilia infection. The mortality rate in HCT recipients was significantly higher than that in non-HCT patients (relative risk 5.7, P=0.04), and we identified seven patients with pulmonary hemorrhage due to S. maltophilia, exclusively in the HCT cohort. Six of these latter seven patients died within 1 day from the onset of hemorrhage and the isolate was identified after death in most cases; one patient, who received empiric therapy for S. maltophilia and granulocyte transfusion, survived for more than 2 weeks. The patients with pulmonary hemorrhage had a more severe and longer duration of neutropenia, persistent fever despite of the use of broad-spectrum antibiotics, complication by pneumonia and higher C-reactive protein levels than those without pulmonary hemorrhage. In conclusion, S. maltophilia was associated with fulminant and fatal pulmonary hemorrhage in HCT recipients. Empiric therapy with antibiotics before the onset of pulmonary hemorrhage may be effective in HCT recipients who carry the conditions identified.

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References

  1. 1

    Looney WJ, Narita M, Muhlemann K . Stenotrophomonas maltophilia: an emerging opportunist human pathogen. Lancet Infect Dis 2009; 9: 312–323.

  2. 2

    Hoefel D, Monis PT, Grooby WL, Andrews S, Saint CP . Profiling bacterial survival through a water treatment process and subsequent distribution system. J Appl Microbiol 2005; 99: 175–186.

  3. 3

    Spencer RC . The emergence of epidemic, multiple-antibiotic-resistant Stenotrophomonas (Xanthomonas) maltophilia and Burkholderia (Pseudomonas) cepacia. J Hosp Infect 1995; 30 (Suppl): 453–464.

  4. 4

    Cervia JS, Ortolano GA, Canonica FP . Hospital tap water as a source of Stenotrophomonas maltophilia infection. Clin Infect Dis 2008; 46: 1485–1487.

  5. 5

    Khardori N, Reuben A, Rosenbaum B, Rolston K, Bodey GP . In vitro susceptibility of Xanthomonas (Pseudomonas) maltophilia to newer antimicrobial agents. Antimicrob Agents Chemother 1990; 34: 1609–1610.

  6. 6

    Nicodemo AC, Paez JI . Antimicrobial therapy for Stenotrophomonas maltophilia infections. Eur J Clin Microbiol Infect Dis 2007; 26: 229–237.

  7. 7

    Safdar A, Rolston KV . Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer. Clin Infect Dis 2007; 45: 1602–1609.

  8. 8

    Boktour M, Hanna H, Ansari S, Bahna B, Hachem R, Tarrand J et alCentral venous catheter and Stenotrophomonas maltophilia bacteremia in cancer patients. Cancer 2006; 106: 1967–1973.

  9. 9

    Metan G, Hayran M, Hascelik G, Uzun O . Which patient is a candidate for empirical therapy against Stenotrophomonas maltophilia bacteraemia? An analysis of associated risk factors in a tertiary care hospital. Scand J Infect Dis 2006; 38: 527–531.

  10. 10

    Trouillet JL, Chastre J, Vuagnat A, Joly-Guillou ML, Combaux D, Dombret MC et alVentilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998; 157: 531–539.

  11. 11

    Martino R, Martinez C, Pericas R, Salazar R, Solá C, Brunet S et alBacteremia due to glucose non-fermenting gram-negative bacilli in patients with hematological neoplasias and solid tumors. Eur J Clin Microbiol Infect Dis 1996; 15: 610–615.

  12. 12

    Labarca JA, Leber AL, Kern VL, Territo MC, Brankovic LE, Bruckner DA et alOutbreak of Stenotrophomonas maltophilia bacteremia in allogenic bone marrow transplant patients: role of severe neutropenia and mucositis. Clin Infect Dis 2000; 30: 195–197.

  13. 13

    Araoka H, Baba M, Yoneyama A . Risk factors for mortality among patients with Stenotrophomonas maltophilia bacteremia in Tokyo, Japan, 1996-2009. Eur J Clin Microbiol Infect Dis 2010; 29: 605–608.

  14. 14

    Micozzi A, Venditti M, Monaco M, Friedrich A, Taglietti F, Santilli S et alBacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies. Clin Infect Dis 2000; 31: 705–711.

  15. 15

    Muder RR, Harris AP, Muller S, Edmond M, Chow JW, Papadakis K et alBacteremia due to Stenotrophomonas (Xanthomonas) maltophilia: a prospective, multicenter study of 91 episodes. Clin Infect Dis 1996; 22: 508–512.

  16. 16

    Paez JI, Tengan FM, Barone AA, Levin AS, Costa SF . Factors associated with mortality in patients with bloodstream infection and pneumonia due to Stenotrophomonas maltophilia. Eur J Clin Microbiol Infect Dis 2008; 27: 901–906.

  17. 17

    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.

  18. 18

    Chaplow R, Palmer B, Heyderman R, Moppett J, Marks DI . Stenotrophomonas maltophilia bacteraemia in 40 haematology patients: risk factors, therapy and outcome. Bone Marrow Transplant 2010; 45: 1109–1110.

  19. 19

    Yeshurun M, Gafter-Gvili A, Thaler M, Keller N, Nagler A, Shimoni A . Clinical characteristics of Stenotrophomonas maltophilia infection in hematopoietic stem cell transplantation recipients: a single center experience. Infection 2010; 38: 211–215.

  20. 20

    Friedman ND, Korman TM, Fairley CK, Franklin JC, Spelman DW . Bacteraemia due to Stenotrophomonas maltophilia: an analysis of 45 episodes. J Infect 2002; 45: 47–53.

  21. 21

    Korvick JA, Bryan CS, Farber B, Beam TR, Schenfeld L, Muder RR et alProspective observational study of Klebsiella bacteremia in 230 patients: outcome for antibiotic combinations versus monotherapy. Antimicrob Agents Chemother 1992; 36: 2639–2644.

  22. 22

    Chow JW, Yu VL . Combination antibiotic therapy versus monotherapy for gram-negative bacteraemia: a commentary. Int J Antimicrob Agents 1999; 11: 7–12.

  23. 23

    Portugal RD, Garnica M, Nucci M . Index to predict invasive mold infection in high-risk neutropenic patients based on the area over the neutrophil curve. J Clin Oncol 2009; 27: 3849–3854.

  24. 24

    Majhail NS, Parks K, Defor TE, Weisdorf DJ . Diffuse alveolar hemorrhage and infection-associated alveolar hemorrhage following hematopoietic stem cell transplantation: related and high-risk clinical syndromes. Biol Blood Marrow Transplant 2006; 12: 1038–1046.

  25. 25

    Wanko SO, Broadwater G, Folz RJ, Chao NJ . Diffuse alveolar hemorrhage: retrospective review of clinical outcome in allogeneic transplant recipients treated with aminocaproic acid. Biol Blood Marrow Transplant 2006; 12: 949–953.

  26. 26

    Gupta S, Jain A, Warneke CL, Gupta A, Shannon VR, Morice RC et alOutcome of alveolar hemorrhage in hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2007; 40: 71–78.

  27. 27

    Elsner HA, Duhrsen U, Hollwitz B, Kaulfers PM, Hossfeld DK . Fatal pulmonary hemorrhage in patients with acute leukemia and fulminant pneumonia caused by Stenotrophomonas maltophilia. Ann Hematol 1997; 74: 155–161.

  28. 28

    Rousseau A, Morcos M, Amrouche L, Foïs E, Casetta A, Rio B et alLethal pulmonary hemorrhage caused by a fulminant Stenotrophomonas maltophilia respiratory infection in an acute myeloid leukemia patient. Leuk Lymphoma 2004; 45: 1293–1296.

  29. 29

    Ortin X, Jaen-Martinez J, Rodriguez-Luaces M, Alvaro T, Font L . Fatal pulmonary hemorrhage in a patient with myelodysplastic syndrome and fulminant pneumonia caused by Stenotrophomonas maltophilia. Infection 2007; 35: 201–202.

  30. 30

    Takahashi N, Yoshioka T, Kameoka Y, Tagawa H, Fujishima N, Saitoh H et alFatal hemorrhagic pneumonia caused by Stenotrophomanas maltophilia in a patient with non-Hodgkin lymphoma. J Infect Chemother 2011; 17: 858–862.

  31. 31

    O'Brien M, Davis GH . Enzymatic profile of Pseudomonas maltophilia. J Clin Microbiol 1982; 16: 417–421.

  32. 32

    Windhorst S, Frank E, Georgieva DN, Genov N, Buck F, Borowski P et alThe major extracellular protease of the nosocomial pathogen Stenotrophomonas maltophilia: characterization of the protein and molecular cloning of the gene. J Biol Chem 2002; 277: 11042–11049.

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Correspondence to T Fukuda.

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Tada, K., Kurosawa, S., Hiramoto, N. et al. Stenotrophomonas maltophilia infection in hematopoietic SCT recipients: high mortality due to pulmonary hemorrhage. Bone Marrow Transplant 48, 74–79 (2013) doi:10.1038/bmt.2012.87

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Keywords

  • Stenotrophomonas maltophilia
  • SCT
  • pulmonary hemorrhage

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