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

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...

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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
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Abstract	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.
AbstractList	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. 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. 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. Bone Marrow Transplantation (2013) 48, 74-79; doi: 10.1038/bmt.2012.87; published online 28 May 2012 Keywords: Stenotrophomonas maltophilia; SCT; pulmonary hemorrhage
Audience	Academic
Author	Tobinai, K Maeshima, A M Okinaka, K Mori, S-I Ueno, N Fukuda, T Hiramoto, N Tanosaki, R Tada, K Yamashita, T Heike, Y Asakura, Y Kim, S-W Kurosawa, S
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Keywords	pulmonary hemorrhage SCT Pseudomonadales Stenotrophomonas maltophilia Hematology Mortality Lung Recipient Respiratory system Hemorrhage Infection Bacteria Pseudomonadaceae Hematopoietic stem cell transplantation
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Snippet	To clarify the clinical features and outcome of Stenotrophomonas maltophilia infection among hematopoietic SCT (HCT) recipients, we retrospectively reviewed... To clarify the clinical features and outcome of Stenotrophomonas maltophilia infection among hematopoietic SCT (HCT) recipients, we retrospectively reviewed...
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SubjectTerms	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
Title	Stenotrophomonas maltophilia infection in hematopoietic SCT recipients: high mortality due to pulmonary hemorrhage
URI	https://link.springer.com/article/10.1038/bmt.2012.87 https://www.ncbi.nlm.nih.gov/pubmed/22635245 https://www.proquest.com/docview/1267527578 https://search.proquest.com/docview/1272726014 https://search.proquest.com/docview/1273350395
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