Abstract
BackgroundFatal hemorrhagic pneumonia is one of the most severe manifestations of Stenotrophomonas maltophilia (SM) infections. Here, we aimed to investigate the clinical characteristics of SM bacteremia and to identify the risk factors of hemorrhagic pneumonia caused by SM in patients with hematologic diseases.MethodsThe clinical records of 55 patients diagnosed with hematologic diseases and SM bacteremia were retrospectively reviewed. We compared patients’ clinical characteristics and outcomes between the hemorrhagic pneumonia group and non-hemorrhagic pneumonia group.ResultsTwenty-seven (49.1%) patients developed hemorrhagic pneumonia. The overall mortality rate of SM bacteremia was 67.3%. Hemorrhagic pneumonia (adjusted HR 2.316, 95% CI 1.140–4.705; P = 0.020) was an independent risk factor of 30-day mortality in hematological patients with SM bacteremia. Compared with the non-hemorrhagic pneumonia group, patients in the hemorrhagic pneumonia group were older and showed clinical manifestations as higher proportions of isolated SM in sputum culture, neutropenia and elevated procalcitonin (PCT). Multivariate analysis showed that neutropenia, high levels of PCT, prior tigecycline therapy within 1 month were independent risk factors associated with hemorrhagic pneumonia.ConclusionsNeutropenia, high level of PCT and prior tigecycline therapy within 1 month were significant independent predictors of hemorrhagic pneumonia in hematologic patients with SM bacteremia. Due to no effective antibiotics to prevent hemorrhagic pneumonia, prophylaxis of SM infection and its progression to hemorrhagic pneumonia is particularly important.
Highlights
Stenotrophomonas maltophilia (SM) is a nonfermentative gram-negative bacterium without highly virulent widely found in nature, and rarely causes infection in the normal immune population [1]
SM has been becoming a common cause of opportunistic infections in immunocompromised patients, especially in patients diagnosed with hematologic diseases, and can cause serious infections, such as bacteremia or hemorrhagic pneumonia [2,3,4,5,6]
The most common underlying diseases diagnosed when admitted to hospital were acute myeloid leukemia (AML) (31 cases, 56.4%), followed by acute lymphoblastic leukemia (ALL) (12 cases, 21.8%), non-Hodgkin’s lymphoma (NHL) (6 cases, 10.6%), aplastic anemia (AA) (3 cases, 5.5%), hemophagocytic syndrome (HLH) (2 cases, 3.6%) and myelodysplastic syndrome (MDS)(1 case, 1.8%)
Summary
Stenotrophomonas maltophilia (SM) is a nonfermentative gram-negative bacterium without highly virulent widely found in nature, and rarely causes infection in the normal immune population [1]. In patients with hematologic malignancies and/or hematopoietic stem cell transplantation (HSCT) recipients, SM can cause fatal hemorrhagic pneumonia, and the mortality is nearly 100% [10, 12,13,14,15,16,17]. Only a few reports have performed a statistical analysis to identify the risk factors of hemorrhagic pneumonia caused by SM [10, 12]. Fatal hemorrhagic pneumonia is one of the most severe manifestations of Stenotrophomonas maltophilia (SM) infections. We aimed to investigate the clinical characteristics of SM bacteremia and to identify the risk factors of hemorrhagic pneumonia caused by SM in patients with hematologic diseases
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