Abstract
BackgroundStenotrophomonas maltophilia (S. maltophilia) bacteremia causes significant morbidity and mortality in immunocompromised hosts. However, incidence and risk factors for mortality in S. maltophilia bacteremia following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain controversial. The primary aim of this study is to clarify factors associated with poor prognosis of allo-HSCT recipients with S. maltophilia bacteremia.MethodsFrom January 2005 to December 2014, patients with hematological diseases and S. maltophilia bacteremia at a single transplantation center in Japan were examined for incidence and 90-day mortality. Prognostic factors associated with 90-day mortality among allo-HSCT recipients were analyzed by log-rank test, and significant variables in the univariate analysis were included in the multivariate Cox proportional-hazards regression model.ResultsA total of 65 patients, including 47 patients undergoing allo-HSCT, developed S. maltophilia bacteremia. The incidence of S. maltophilia bacteremia was significantly higher in allo-HSCT recipients compared to patients not receiving allo-HSCT (6.53 vs. 0.36 per 100 admissions, respectively; p < 0.01). The overall 90-day mortality in allo-HSCT recipients was 43%. Independent risk factors for 90-day mortality were low serum albumin (<3.0 g/dl) (HR = 10.86; 95% CI, 3.27–36.12) and high serum C-reactive protein (CRP) (≥10.0 mg/dl) (HR = 3.28; 95% CI, 1.00–10.72). Among 9 patients with both high CRP and low albumin, 5 had pneumonia at the onset of bacteremia and the remaining 4 patients developed pneumonia in a median of 3 days (range, 1 to 8 days) even under effective treatment. All 9 patients eventually died in a median of 2 days (range, 2 to 32 days). The probabilities of developing pneumonia in patients with or without high CRP and low albumin levels were 100% (9/9) and 10.5% (4/38), respectively (p < 0.01).ConclusionsAllo-HSCT recipients had higher rates of S. maltophilia bacteremia than did patients not receiving allo-HSCT. High serum CRP and low serum albumin at the onset of bacteremia are predictive of disease progression to pneumonia and poor prognosis.
Highlights
Stenotrophomonas maltophilia (S. maltophilia) bacteremia causes significant morbidity and mortality in immunocompromised hosts
High serum C-reactive protein (CRP) and low serum albumin at the onset of bacteremia are predictive of disease progression to pneumonia and poor prognosis
Few studies have examined the precise incidence rate of S. maltophilia bacteremia in allo-hematopoietic stem cell transplantation (HSCT) recipients, despite the increasing incidence of this infection in heterogeneous populations including allo-HSCT recipients and patients receiving chemotherapy or auto-HSCT [10,11,12]
Summary
Stenotrophomonas maltophilia (S. maltophilia) bacteremia causes significant morbidity and mortality in immunocompromised hosts. S. maltophilia possesses a limited pathogenicity, the organism can cause serious infections in immunocompromised hosts, especially in hematopoietic stem cell transplantation (HSCT) recipients [3, 4]. As allo-HSCT recipients are a severely immunocompromised population with complex comorbidities, these individuals are more likely to have multiple risk factors and to develop fatal infections such as hemorrhagic pneumonia than are patients receiving chemotherapy or autologous (auto)-HSCT [3, 5,6,7,8]. Few studies have examined the precise incidence rate of S. maltophilia bacteremia in allo-HSCT recipients, despite the increasing incidence of this infection in heterogeneous populations including allo-HSCT recipients and patients receiving chemotherapy or auto-HSCT [10,11,12]. Risk factors for mortality focusing on allo-HSCT recipients have not been investigated in depth
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