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Clinical predictors of Stenotrophomonas maltophilia bacteremia in adult patients with hematologic malignancy

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Abstract

Stenotrophomonas maltophilia (SM) has emerged as an important nosocomial pathogen with high morbidity and mortality. Because of its unique antimicrobial susceptibility pattern, appropriate antimicrobial therapy for SM bacteremia is still challenging, especially in immunocompromised patients. The present study was performed to assess clinical predictors of SM bacteremia in adult patients with hematologic malignancy. From 2006 through 2016, a case-control study was performed at a tertiary-care hospital. Case patients were defined as SM bacteremia in patients with hematologic malignancy. Date- and location-matched controls were selected from among patients with gram-negative bacteremia (GNB) other than SM. A total of 118 cases of SM bacteremia were identified and compared to 118 controls. While pneumonia was the most common source of SM bacteremia, centralline-associated infection was most common in the controls. The overall 30-day mortality rate of cases with SM bacteremia was significantly higher than that of the controls (61.0 and 32.2%, respectively; P < 0.001). A multivariable analysis showed that polymicrobial infection, previous SM isolation, the number of antibiotics previously used ≥ 3, and breakthrough bacteremia during carbapenem therapy were significantly associated with SM bacteremia (all P < 0.01). Previous use of trimethoprim/sulfamethoxazole (TMP/SMX) was negatively association with SM bacteremia (P = 0.002). Our data suggest that SM is becoming a significant pathogen in patients with hematologic malignancy. Several clinical predictors of SM bacteremia can be used for appropriate antimicrobial therapy in hematologic patients with suspected GNB.

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References

  1. Looney WJ, Narita M, Muhlemann K (2009) Stenotrophomonas maltophilia: an emerging opportunist human pathogen. Lancet Infect Dis 9(5):312–323. https://doi.org/10.1016/S1473-3099(09)70083-0

    Article  CAS  PubMed  Google Scholar 

  2. Brooke JS (2012) Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clin Microbiol Rev 25(1):2–41. https://doi.org/10.1128/CMR.00019-11

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Safdar A, Rolston KV (2007) Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer. Clin Infect Dis 45(12):1602–1609. https://doi.org/10.1086/522998

    Article  PubMed  Google Scholar 

  4. Crossman LC, Gould VC, Dow JM, Vernikos GS, Okazaki A, Sebaihia M, Saunders D, Arrowsmith C, Carver T, Peters N, Adlem E, Kerhornou A, Lord A, Murphy L, Seeger K, Squares R, Rutter S, Quail MA, Rajandream MA, Harris D, Churcher C, Bentley SD, Parkhill J, Thomson NR, Avison MB (2008) The complete genome, comparative and functional analysis of Stenotrophomonas maltophilia reveals an organism heavily shielded by drug resistance determinants. Genome Biol 9(4):R74. https://doi.org/10.1186/gb-2008-9-4-r74

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cho SY, Kang CI, Kim J, Ha YE, Chung DR, Lee NY, Peck KR, Song JH (2014) Can levofloxacin be a useful alternative to trimethoprim-sulfamethoxazole for treating Stenotrophomonas maltophilia bacteremia? Antimicrob Agents Chemother 58(1):581–583. https://doi.org/10.1128/AAC.01682-13

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wang YL, Scipione MR, Dubrovskaya Y, Papadopoulos J (2014) Monotherapy with fluoroquinolone or trimethoprim-sulfamethoxazole for treatment of Stenotrophomonas maltophilia infections. Antimicrob Agents Chemother 58(1):176–182. https://doi.org/10.1128/AAC.01324-13

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cho SY, Lee DG, Choi SM, Park C, Chun HS, Park YJ, Choi JK, Lee HJ, Park SH, Choi JH, Yoo JH (2015) Stenotrophomonas maltophilia bloodstream infection in patients with hematologic malignancies: a retrospective study and in vitro activities of antimicrobial combinations. BMC Infect Dis 15(1):69. https://doi.org/10.1186/s12879-015-0801-7

    Article  PubMed  PubMed Central  Google Scholar 

  8. Micozzi A, Venditti M, Monaco M, Friedrich A, Taglietti F, Santilli S, Martino P (2000) Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies. Clin Infect Dis 31(3):705–711. https://doi.org/10.1086/314043

    Article  CAS  PubMed  Google Scholar 

  9. Victor MA, Arpi M, Bruun B, Jonsson V, Hansen MM (1994) Xanthomonas maltophilia bacteremia in immunocompromised hematological patients. Scand J Infect Dis 26(2):163–170. https://doi.org/10.3109/00365549409011780

    Article  CAS  PubMed  Google Scholar 

  10. Apisarnthanarak A, Mayfield JL, Garison T, McLendon PM, DiPersio JF, Fraser VJ, Polish LB (2003) Risk factors for Stenotrophomonas maltophilia bacteremia in oncology patients: a case-control study. Infect Control Hosp Epidemiol 24(4):269–274. https://doi.org/10.1086/502197

    Article  PubMed  Google Scholar 

  11. Metan G, Hayran M, Hascelik G, Uzun O (2006) Which patient is a candidate for empirical therapy against Stenotrophomonas maltophilia bacteraemia? An analysis of associated risk factors in a tertiary care hospital. Scand J Infect Dis 38(6–7):527–531. https://doi.org/10.1080/00365540500452481

    Article  PubMed  Google Scholar 

  12. Hotta G, Matsumura Y, Kato K, Nakano S, Yunoki T, Yamamoto M, Nagao M, Ito Y, Takakura S, Ichiyama S (2014) Risk factors and outcomes of Stenotrophomonas maltophilia bacteraemia: a comparison with bacteraemia caused by Pseudomonas aeruginosa and Acinetobacter species. PLoS One 9(11):e112208. https://doi.org/10.1371/journal.pone.0112208

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sumida K, Chong Y, Miyake N, Akahoshi T, Yasuda M, Shimono N, Shimoda S, Maehara Y, Akashi K (2015) Risk factors associated with Stenotrophomonas maltophilia bacteremia: a matched case-control study. PLoS One 10(7):e0133731. https://doi.org/10.1371/journal.pone.0133731

    Article  PubMed  PubMed Central  Google Scholar 

  14. Seifert H (2009) The clinical importance of microbiological findings in the diagnosis and management of bloodstream infections. Clin Infect Dis 48(Suppl 4):S238–S245. https://doi.org/10.1086/598188

    Article  PubMed  Google Scholar 

  15. Huh K, Kim J, Cho SY, Ha YE, Joo EJ, Kang CI, Chung DR, Lee NY, Song JH, Peck KR, Korean Network for Study on Infectious Diseases (2013) Continuous increase of the antimicrobial resistance among gram-negative pathogens causing bacteremia: a nationwide surveillance study by the Korean Network for Study on Infectious Diseases (KONSID). Diagn Microbiol Infect Dis 76(4):477–482. https://doi.org/10.1016/j.diagmicrobio.2013.04.014

    Article  CAS  PubMed  Google Scholar 

  16. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8

    Article  CAS  PubMed  Google Scholar 

  17. Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL (2001) Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 286(14):1754–1758. https://doi.org/10.1001/jama.286.14.1754

    Article  CAS  PubMed  Google Scholar 

  18. Lee JY, Kang CI, Ko JH, Lee WJ, Seok HR, Park GE, Cho SY, Ha YE, Chung DR, Lee NY, Peck KR, Song JH (2016) Clinical features and risk factors for development of breakthrough gram-negative bacteremia during carbapenem therapy. Antimicrob Agents Chemother 60(11):6673–6678. https://doi.org/10.1128/AAC.00984-16

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Metan G, Uzun O (2005) Impact of initial antimicrobial therapy in patients with bloodstream infections caused by Stenotrophomonas maltophilia. Antimicrob Agents Chemother 49(9):3980–3981. https://doi.org/10.1128/AAC.49.9.3980-3981.2005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kang CI, Song JH, Chung DR, Peck KR, Ko KS, Yeom JS, Ki HK, Son JS, Lee SS, Kim YS, Jung SI, Kim SW, Chang HH, Ryu SY, Kwon KT, Lee H, Moon C, Korean Network for Study of Infectious Diseases (2011) Risk factors and pathogenic significance of severe sepsis and septic shock in 2286 patients with gram-negative bacteremia. J Inf Secur 62(1):26–33. https://doi.org/10.1016/j.jinf.2010.10.010

    Google Scholar 

  21. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, Rochwerg B, Rubenfeld GD, Angus DC, Annane D, Beale RJ, Bellinghan GJ, Bernard GR, Chiche JD, Coopersmith C, De Backer DP, French CJ, Fujishima S, Gerlach H, Hidalgo JL, Hollenberg SM, Jones AE, Karnad DR, Kleinpell RM, Koh Y, Lisboa TC, Machado FR, Marini JJ, Marshall JC, Mazuski JE, McIntyre LA, McLean AS, Mehta S, Moreno RP, Myburgh J, Navalesi P, Nishida O, Osborn TM, Perner A, Plunkett CM, Ranieri M, Schorr CA, Seckel MA, Seymour CW, Shieh L, Shukri KA, Simpson SQ, Singer M, Thompson BT, Townsend SR, Van der Poll T, Vincent JL, Wiersinga WJ, Zimmerman JL, Dellinger RP (2017) Surviving sepsis campaign: international guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med 43(3):304–377. https://doi.org/10.1007/s00134-017-4683-6

    Article  PubMed  Google Scholar 

  22. Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, Kallen A, Limbago B, Fridkin S, National Healthcare Safety Network Team, Participating Nhsn Facilities (2013) Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol 34(1):1–14. https://doi.org/10.1086/668770

    Article  PubMed  Google Scholar 

  23. Jung JY, Park MS, Kim SE, Park BH, Son JY, Kim EY, Lim JE, Lee SK, Lee SH, Lee KJ, Kang YA, Kim SK, Chang J, Kim YS (2010) Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit. BMC Infect Dis 10(1):228. https://doi.org/10.1186/1471-2334-10-228

    Article  PubMed  PubMed Central  Google Scholar 

  24. Cohen R, Babushkin F, Cohen S, Afraimov M, Shapiro M, Uda M, Khabra E, Adler A, Ben Ami R, Paikin S (2017) A prospective survey of Pseudomonas aeruginosa colonization and infection in the intensive care unit. Antimicrob Resist Infect Control 6(1):7. https://doi.org/10.1186/s13756-016-0167-7

    Article  PubMed  PubMed Central  Google Scholar 

  25. Araoka H, Baba M, Yoneyama A (2010) Risk factors for mortality among patients with Stenotrophomonas maltophilia bacteremia in Tokyo, Japan, 1996-2009. Eur J Clin Microbiol Infect Dis 29(5):605–608. https://doi.org/10.1007/s10096-010-0882-6

    Article  CAS  PubMed  Google Scholar 

  26. Aisenberg G, Rolston KV, Dickey BF, Kontoyiannis DP, Raad II, Safdar A (2007) Stenotrophomonas maltophilia pneumonia in cancer patients without traditional risk factors for infection, 1997-2004. Eur J Clin Microbiol Infect Dis 26(1):13–20. https://doi.org/10.1007/s10096-006-0243-7

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Si-Ho Kim and Sun Young Cho contributed equally to this work.

Authors and Affiliations

  1. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, South Korea

    Si-Ho Kim, Sun Young Cho, Cheol-In Kang, Hyeri Seok, Kyungmin Huh, Young Eun Ha, Doo Ryeon Chung, Kyong Ran Peck & Jae-Hoon Song

  2. Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Nam Yong Lee

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  1. Si-Ho Kim
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Corresponding author

Correspondence to Cheol-In Kang.

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This study was approved by the institutional review board at our institution (number: 2017-08-016-001). All procedures were performed in accordance with the principles of the Declaration of Helsinki.

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The authors declare that they have no conflict of interest.

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Kim, SH., Cho, S.Y., Kang, CI. et al. Clinical predictors of Stenotrophomonas maltophilia bacteremia in adult patients with hematologic malignancy. Ann Hematol 97, 343–350 (2018). https://doi.org/10.1007/s00277-017-3178-4

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  • DOI: https://doi.org/10.1007/s00277-017-3178-4

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