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

• Published in: Bone marrow transplantation (Basingstoke) Vol. 48; no. 1; pp. 74 - 79
• Main Authors: Tada, K, Kurosawa, S, Hiramoto, N, Okinaka, K, Ueno, N, Asakura, Y, Kim, S-W, Yamashita, T, Mori, S-I, Heike, Y, Maeshima, A M, Tanosaki, R, Tobinai, K, Fukuda, T
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-01-2013; Nature Publishing Group
• Subjects: 631/250/1904; 631/326/22/1290; 692/699/1785; 692/699/255/1318; Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - therapeutic use; Antibiotics; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; C-reactive protein; Cell Biology; Child; Child, Preschool; Cohort Studies; Complications and side effects; Drug Resistance, Multiple, Bacterial; Female; Fever; Gram-negative bacterial infections; Gram-Negative Bacterial Infections - immunology; Gram-Negative Bacterial Infections - microbiology; Gram-Negative Bacterial Infections - physiopathology; Gram-Negative Bacterial Infections - therapy; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Hemopoiesis; Hemorrhage; Hemorrhage - epidemiology; Hemorrhage - etiology; Hemorrhage - mortality; Humans; Immunocompromised Host - drug effects; Incidence; Infection; Internal Medicine; Japan; Japan - epidemiology; Leukocytes (granulocytic); Lung; Lung diseases; Lung Diseases - epidemiology; Lung Diseases - etiology; Lung Diseases - mortality; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neutropenia; Neutropenia - epidemiology; Neutropenia - etiology; Neutropenia - physiopathology; original-article; Pneumonia; Pneumonia, Bacterial - immunology; Pneumonia, Bacterial - microbiology; Pneumonia, Bacterial - physiopathology; Pneumonia, Bacterial - therapy; Public Health; Retrospective Studies; Risk assessment; Risk factors; Severity of Illness Index; Stem cell transplantation; Stem Cells; Stenotrophomonas maltophilia; Stenotrophomonas maltophilia - drug effects; Stenotrophomonas maltophilia - immunology; Stenotrophomonas maltophilia - isolation & purification; Transfusion; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Young Adult; Japan; pulmonary hemorrhage; SCT; Pseudomonadales; Stenotrophomonas maltophilia; Hematology; Mortality; Lung; Recipient; Respiratory system; Hemorrhage; Infection; Bacteria; Pseudomonadaceae; Hematopoietic stem cell transplantation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2012.87

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.