Advertisement

Infection

pp 1–8 | Cite as

The clinical impact of Stenotrophomonas maltophilia bacteremia on the 30-day mortality rate in patients with hematologic disorders: a single-institution experience

  • Haiyan Bao
  • Yusen Qiao
  • Dan Liu
  • Jia Chen
  • Xiaojin Wu
  • Xiaohui Hu
  • Xiao Ma
  • Depei WuEmail author
Original Paper

Abstract

Objective

Stenotrophomonas maltophilia (SM) is an important nosocomial pathogen, particularly in immunocompromised patients due to their adverse antimicrobial susceptibility pattern. The objective of this article was to investigate the clinical impact of SM bacteremia on the 30-day mortality rate and identify the risk factors of the cause of mortality in patients with hematologic disorders.

Methods

We retrospectively reviewed the clinical data in patients diagnosed with hematological disorders and SM bacteremia over an 8-year period from July 2010 to July 2018 at a 248-bed hematology department. We compared patients’ clinical characteristics and outcomes between the non-survivor and survivor groups.

Results

The overall incidence of SM bacteremia was 25.1 per 10,000 admissions. There were 59 patients (median age: 35 years; 57.6% males) included in the study with an overall SM bacteremia-related 30-day mortality of 44.1%. Multi-drug resistance was common. In vitro susceptibility is higher to ceftazidime (72.9%), ciprofloxacin (66.1%) and cefoperazone/sulbactam (59.3%). The risk factors identified in the univariate analysis were catheter re-implantation, accompanying polymicrobial infection, inadequate initial antimicrobial treatment, APACHE II score, temperature > 39 °C, septic shock, respiratory failure, and non-remission post treatment for primary diseases. Multivariate analysis further confirmed that inadequate initial antimicrobial treatment, respiratory failure, and non-remission after treatment for hematological diseases are independent risk factors associated with mortality (P = 0.001, 0.002 and 0.007, respectively).

Conclusions

Our study suggests that SM bacteremia is highly associated with increased mortality in patients with hematologic diseases. Early detection, prompt comprehensive management including initiation of combined sensitive antibiotics, respiratory monitoring and support, platelet infusion, and strategies to improve patients’ remission status are recommended to improve the overall survival in patients with SM bacteremia.

Keywords

Stenotrophomonas maltophilia Bacteremia Hematologic disorders Mortality 

Notes

Funding

This work was supported by the National Key R&D Program of China (2016YFC0902800, 2017YFA0104502, 2017ZX09304021), Innovation Capability Development Project of Jiangsu Province (BM2015004), Jiangsu Provincial Key Medical Center (YXZXA2016002), Jiangsu Medical Outstanding Talents Project (JCRCA2016002), and Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Research Ethics Committee of the First Affiliated Hospital of Soochow University.

References

  1. 1.
    Brooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clin Microbiol Rev. 2012;25:2–41.CrossRefGoogle Scholar
  2. 2.
    Hugh R, Ryschenkow E. Pseudomonas maltophilia, an Alcaligenes-like species. J Gen Microbiol. 1961;26:123–32.CrossRefGoogle Scholar
  3. 3.
    Khardori N, Elting L, Wong E, Schable B, Bodey PG. Nosocomial infections due to Xanthomonas maltophilia (Pseudomonas maltophilia) in patients with cancer. Rev Infect Dis. 1990;12:997–1003.CrossRefGoogle Scholar
  4. 4.
    Senol E. Stenotrophomonas maltophilia: the significance and role as a nosocomial pathogen. J Hosp Infect. 2004;57:1–7.CrossRefGoogle Scholar
  5. 5.
    Rathmanathan A, Waterer GW. Significance of positive Stenotrophomonas maltophilia culture in acute respiratory tract infection. Eur Respir J. 2005;25:911–4.CrossRefGoogle Scholar
  6. 6.
    Garazi M, Singer C, Tai J, Ginocchio CC. Bloodstream infections caused by Stenotrophomonas maltophilia: a seven-year review. J Hosp Infect. 2012;81:114–8.CrossRefGoogle Scholar
  7. 7.
    Rostoff P, Paradowski A, Gackowski A, Konduracka E, El Massri N, Gajos G, Pfitzner R, Drwila R, Sadowski J, Piwowarska W. Stenotrophomonas maltophilia pacemaker endocarditis in a patient with d-transposition of the great arteries after atrial switch procedure. Int J Cardiol. 2010;145:92–5.CrossRefGoogle Scholar
  8. 8.
    Yemisen M, Mete B, Tunali Y, Yentur E, Ozturk R. A meningitis case due to Stenotrophomonas maltophilia and review of the literature. Int J Infect Dis. 2008;12:125–7.CrossRefGoogle Scholar
  9. 9.
    Ishihara S, Yasuda M, Nakano M, Ozeki S, Deguchi T, Ban Y, Kawada Y. Significance of Stenotrophomonas maltophilia urinary tract infections. J Infect Chemother. 1998;4:20–3.CrossRefGoogle Scholar
  10. 10.
    Sakhini E, Weissmann A, Oren I. Fulminant Stenotrophomonas maltophilia soft tissue infection in immunocompromised patients: an outbreak transmitted via tap water. Am J Med Sci. 2002;323:269–72.CrossRefGoogle Scholar
  11. 11.
    Gladman G, Connor PJ, Williams RF, David TJ. Controlled study of Pseudomonas cepacia and Pseudomonas maltophilia in cystic fibrosis. Arch Dis Child. 1992;67:192–5.CrossRefGoogle Scholar
  12. 12.
    Bauernfeind A, Bertele RM, Harms K, Horl G, Jungwirth R, Petermuller C, Weisslein-Pfister C. Qualitative and quantitative microbiological analysis of sputa of 102 patients with cystic fibrosis. Infection. 1987;15:270–7.CrossRefGoogle Scholar
  13. 13.
    Looney WJ, Narita M, Muhlemann K. Stenotrophomonas maltophilia: an emerging opportunist human pathogen. Lancet Infect Dis. 2009;9:312–23.CrossRefGoogle Scholar
  14. 14.
    Araoka H, Baba M, Yoneyama A. Risk factors for mortality among patients with Stenotrophomonas maltophilia bacteremia in Tokyo, Japan, 1996–2009. Eur J Clin Microbiol Infect Dis. 2010;29:605–8.CrossRefGoogle Scholar
  15. 15.
    Garica Paez JI, Costa SF. Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia: a systematic review. J Hosp Infect. 2008;70:101–8.CrossRefGoogle Scholar
  16. 16.
    Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309–32.CrossRefGoogle Scholar
  17. 17.
    Lai CH, Wong WW, Chin C, Huang CK, Lin HH, Chen WF, Yu KW, Liu CY. Central venous catheter-related Stenotrophomonas maltophilia bacteraemia and associated relapsing bacteraemia in haematology and oncology patients. Clin Microbiol Infect. 2006;12:986–91.CrossRefGoogle Scholar
  18. 18.
    Cheson BD, Bennett JM, Kopecky KJ, et al. Revised recommendations of the International Working Group for diagnosis, standardization of response criteria, treatment outcomes, and reporting standards for therapeutic trials in acute myeloid leukemia. J Clin Oncol. 2003;21:4642–9.CrossRefGoogle Scholar
  19. 19.
    Brodsky RA, Chen AR, Dorr D, et al. High-dose cyclophosphamide for severe aplastic anemia: long-term follow-up. Blood. 2010;115:2136–41.CrossRefGoogle Scholar
  20. 20.
    Cheson BD, Greenberg PL, Bennett JM, et al. Clinical application and proposal for modification of the International Working Group (IWG) response criteria in myelodysplasia. Blood. 2006;108:419–25.CrossRefGoogle Scholar
  21. 21.
    Cheson BD, Horning SJ, Coiffier B, et al. Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI Sponsored International Working Group. J Clin Oncol. 1999;17:1244.CrossRefGoogle Scholar
  22. 22.
    Durie BG, Harousseau JL, Miguel JS, et al. International uniform response criteria for multiple myeloma. Leukemia. 2006;20:1467–73.CrossRefGoogle Scholar
  23. 23.
    Performance standards for antimicrobial susceptibility testing; Twentieth informational supplement. CLSI Document M100-S20. Clinical and Laboratory Standards Institute, Wayne, PA. 2010.Google Scholar
  24. 24.
    Micozzi A, Venditti M, Monaco M, Friedrich A, Taglietti F, Santilli S, Martino P. Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies. Clin Infect Dis. 2000;31:705–11.CrossRefGoogle Scholar
  25. 25.
    Lakatos B, Jakopp B, Widmer A, Frei R, Pargger H, Elzi L, Battegay M. Evaluation of treatment outcomes for Stenotrophomonas maltophilia bacteraemia. Infection. 2014;42:553–8.CrossRefGoogle Scholar
  26. 26.
    Livermore DM, Woodford N. Carbapenemases: a problem in waiting? Curr Opin Microbiol. 2000;3:489–95.CrossRefGoogle Scholar
  27. 27.
    Zhang L, Li XZ, Poole K. Fluoroquinolone susceptibilities of efflux-mediated multidrug resistant Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Burkholderia cepacia. J Antimicrob Chemother. 2001;48:549–52.CrossRefGoogle Scholar
  28. 28.
    Ba BB, Feghali H, Arpin C, Saux MC, Quentin C. Activities of ciprofloxacin and moxifloxacin against Stenotrophomonas maltophilia and emergence of resistant mutants in an in vitro pharmacokinetic-pharmocodynamic model. Antimicrob Agents Chemother. 2004;48:946–53.CrossRefGoogle Scholar
  29. 29.
    Adegoke AA, Stenström TA, Okoh AI. Stenotrophomonas maltophilia as an emerging ubiquitous pathogen: looking beyond contemporary antibiotic therapy. Front Microbiol. 2017;8:2276.CrossRefGoogle Scholar
  30. 30.
    Ruhnke M, Arnold R, Gastmeier P. Infection control issues in patients with haematological malignancies in the era of multidrug-resistant bacteria. Lancet Oncol. 2014;15:e606–19.CrossRefGoogle Scholar
  31. 31.
    Hotta G, Matsumura Y, Kato K, Nakano S, Yunoki T, Yamamoto M, Nagao M, Ito Y, Takakura S, Ichiyama S. Risk factors and outcomes of Stenotrophomonas maltophilia bacteraemia: a comparison with bacteraemia caused by Pseudomonas aeruginosa and Acinetobacter species. PLoS One. 2014;9:e112208.CrossRefGoogle Scholar
  32. 32.
    Zhanel GG, Golden AR, Zelenitsky S, Wiebe K, Lawrence CK, Adam HJ, et al. Cefiderocol: a siderophore cephalosporin with activity against carbapenem-resistant and multidrug-resistant gram-negative bacilli. Drugs. 2019;79:271–89.CrossRefGoogle Scholar
  33. 33.
    Betriu C, Rodríguez-Avial I, Sánchez BA, Gómez M, Picazo JJ. Comparative in vitro activities of tigecycline (GAR-936) and other antimicrobial agents against Stenotrophomonas maltophilia. J Antimicrob Chemother. 2002;50:758–9.CrossRefGoogle Scholar
  34. 34.
    Zelenitsky SA, Iacovides H, Ariano RE, Harding GK. Antibiotic combinations significantly more active than monotherapy in an in vitro infection model of Stenotrophomonas maltophilia. Diagn Microbiol Infect Dis. 2005;51:39–43.CrossRefGoogle Scholar
  35. 35.
    Cho SY, Lee DG, Choi SM, Park C, Chun HS, Park YJ, Choi JK, Lee HJ, Park SH, Choi JH, Yoo JH. Stenotrophomonas maltophilia bloodstream infection in patients with hematologic malignancies: a retrospective study and in vitro activities of antimicrobial combinations. BMC Infect Dis. 2015;15:69.CrossRefGoogle Scholar
  36. 36.
    Elsner HA, Duhrsen U, Hollwitz B, Kaulfers PM, Hossfeld DK. Fatal pulmonary hemorrhage in patients with acute leukemia and fulminant pneumonia caused by Stenotrophomonas maltophilia. Ann Hematol. 1997;74:155–61.CrossRefGoogle Scholar
  37. 37.
    Rousseau A, Morcos M, Amrouche L, Foïs E, Casetta A, Rio B, Le Tourneaua A, Molina T, Rabbat A, Marie JP, Audouin J. Lethal pulmonary hemorrhage caused by a fulminant Stenotrophomonas maltophilia respiratory infection in an acute myeloid leukemia patient. Leuk Lymphoma. 2004;45:1293–6.CrossRefGoogle Scholar
  38. 38.
    Takahashi N, Yoshioka T, Kameoka Y, Tagawa H, Fujishima N, Saitoh H, Hirokawa M, Enomoto K, Sawada K. Fatal hemorrhagic pneumonia caused by Stenotrophomanas maltophilia in a patient with non-Hodgkin lymphoma. J Infect Chemother. 2011;17:858–62.CrossRefGoogle Scholar
  39. 39.
    Windhorst S, Frank E, Georgieva DN, Genov N, Buck F, Borowski P, Weber W. The major extracellular protease of the nosocomial pathogen Stenotrophomonas maltophilia: characterization of the protein and molecular cloning of the gene. J Biol Chem. 2002;277:11042–9.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Haiyan Bao
    • 1
    • 2
  • Yusen Qiao
    • 1
    • 2
  • Dan Liu
    • 1
  • Jia Chen
    • 1
    • 2
  • Xiaojin Wu
    • 1
    • 2
  • Xiaohui Hu
    • 1
    • 2
  • Xiao Ma
    • 1
    • 2
  • Depei Wu
    • 1
    • 2
    Email author
  1. 1.Jiangsu Institute of HematologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina
  2. 2.Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, National Clinical Research Center for Hematologic DiseasesSoochow UniversitySuzhouChina

Personalised recommendations