Stenotrophomonas maltophilia Infections in Pediatric Patients - Experience at a European Center for Pediatric Hematology and Oncology.

Stefan K Zöllner,Katja Masjosthusmann,Alijda Van Den Heuvel,Stefanie Kampmeier,Neele J Froböse,Andreas Ranft,Andreas H Groll,Christian Reicherts,Heidrun Herbrüggen

doi:10.3389/fonc.2021.752037

Abstract

Stenotrophomonas maltophilia is an important nosocomial pathogen in immunocom-promised individuals and characterized by intrinsic resistance to broad-spectrum antibacterial agents. Limited data exists on its clinical relevance in immunocompromised pediatric patients, particularly those with hematological or oncological disorders. In a retrospective single center cohort study in pediatric patients receiving care at a large european pediatric hematology and oncology department, ten cases of invasive S.maltophilia infections (blood stream infections (BSI), 4; BSI and pneumonia, 3, or soft tissue infection, 2; and pneumonia, 1) were identified between 2010 and 2020. Seven patients had lymphoblastic leukemia and/or were post allogeneic hematopoietic cell transplantation. Invasive S.maltophilia infections occurred in a setting of indwelling central venous catheters, granulocytopenia, defective mucocutaneous barriers, treatment with broad-spectrum antibacterial agents, and admission to the intensive care unit. Whole genome sequencing based typing revealed no genetic relationship among four individual S.maltophilia isolates. The case fatality rate and mortality at 100 days post diagnosis were 40 and 50%, respectively, and three patients died from pulmonary hemorrhage. Invasive S.maltophilia infections are an emerging cause of infectious morbidity in patients receiving care at departments of pediatric hematology and oncology and carry a high case fatality rate.

Highlights

Stenotrophomonas maltophilia is an aerobic non-fermenting Gram-negative bacillus (NGNB) that can be found ubiquitously in the environment [1]
Between January 2010 and July 2020, a total of 502 distinct bloodstream infection (BSI) were identified in children with oncological or hematological disease including patients with autologous or allogeneic hematopoietic cell transplantation (HCT) receiving care at the Department of Pediatric Hematology and Oncology of the University Children’s Hospital of Münster
Published experience in pediatric patients with cancer and/or allogeneic HCT is limited to two separate studies reporting on a total of 24 S.maltophilia BSIs [22, 28] and several larger pediatric series that include a relevant proportion of patients with hematological malignancies or solid tumors [24, 25, 29, 30] (Table 2)

Summary

Introduction

Stenotrophomonas maltophilia (formerly: Pseudomonas or Xanthomonas maltophilia) is an aerobic non-fermenting Gram-negative bacillus (NGNB) that can be found ubiquitously in the environment [1]. To Pseudomonas aeruginosa and Acinetobacter spp., the organism is considered the third most frequent nosocomial pathogen among nonfermentative bacteria [2, 3]. S.maltophilia can cause urinary tract infections, cholangitis, peritonitis, wound infections, eye infections, arthritis, meningitis, and endocarditis [4, 5]. Patients with hematologic malignancies are at high risk for S.maltophilia infection because of chemotherapy-induced neutropenia and immunodeficiency. Frequent exposure to broad-spectrum antibiotics and the presence of central venous catheters further enhance the risk of S.maltophilia infection [6, 7]. The rate of S.maltophilia BSI among BSIs in this patient population has been reported to be as high as 60% [8,9,10,11]

Methods

Results

Conclusion