Clinical features and prognosis of children with hematological malignancies after chemotherapy with Stenotrophomonas maltophilia blood stream infection

Abstract

Objective To investigate the clinical features and prognosis of children with hematological malignancies after chemotherapy accompanied with Stenotrophomonas maltophilia blood stream infection (BSI). Methods The clinical data and antimicrobial susceptibility test of 25 hospitalized children with hematological malignancies who were diagnosed as Stenotrophomonas maltophilia BSI in the Department Pediatric Hematology of Fujian Medical University Union Hospital from January 2013 to May 2018 were analyzed retrospectively. Results A total of 25 children, including 18 males and 7 females with the median age 4 (1-11) years old were diagnosed as hematological malignancies and all received chemotherapy. The frequent risk factors of Stenotrophomonas maltophilia BSI in children with hematological malignancies included prior carbapenem antibiotic for more than 1 week (80%, 20/25), and neutropenia for more than 1 week (68%,17/25) and indwelling central venous catheter (48%, 12/25). Clinically, the main manifestations included neutropenia with fever after chemotherapy; however, anti-pseudomonas cephalosporin/carbicillin antibiotic combined with vancomycin and anti-fungal therapies were ineffective. Drug susceptibility test showed that all strains were sensitive to compound sulfamethoxazole, levofloxacin and minocycline. Before blood culture report, 3 patients died of septic shock, pulmonary hemorrhage and respiratory failure; after blood culture report, the treatment regimens were adjusted to compound sulfamethoxazole combined with cefoperazone sodium and sulbactam sodium (200-260 mg·kg-1·d-1) or levofloxacin anti-infective. Finally, 18 patient was cured, 2 patients died of the bad efficacy of underlying diseases, and 2 patients died of pulmonary hemorrhage. The overall fatality rate was 28% (7/25) and the related mortality rate caused by Stenotrophomonas maltophilia BSI was 20% (5/25). Conclusion Stenotrophomonas maltophilia BSI in children with hematological malignancies after chemotherapy has a high fatality rate, and better basic disease control and appropriate antibacterial therapy are the key to improve the prognosis. Key words: Hematologic neoplasms; Hematologic diseases; Stenotrophomonas maltophilia; Blood stream infection; Child; Prognosis