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Predictive scoring system for distinguishing Stenotrophomonas maltophilia bacteremia from Pseudomonas aeruginosa bacteremia in patients with hematological malignancies

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Abstract

Difficulties in immediately distinguishing Stenotrophomonas maltophilia (SM) bacteremia from Pseudomonas aeruginosa (PA) bacteremia in the clinical setting can lead to treatment delay. We aimed to develop a scoring system to immediately distinguish SM bacteremia from PA bacteremia using clinical indicators. We enrolled cases of SM and PA bacteremia in adult patients with hematological malignancies between January 2011 and June 2018. The patients were randomized into derivation and validation cohorts (2:1), and a clinical prediction tool for SM bacteremia was developed and verified. In total, 88 SM and 85 PA bacteremia cases were identified. In the derivation cohort, the following independent predictors of SM bacteremia were identified: no evidence of PA colonization, antipseudomonal β-lactam breakthrough bacteremia, and central venous catheter insertion. We scored each of the three predictors according to their regression coefficient (2, 2, and 1, respectively). Receiver operating characteristic curve analysis confirmed the score’s predictive performance, with an area under the curve of 0.805. The combined sensitivity and specificity (0.655 and 0.821) was highest with a cut-off value of 4 points. Positive and negative predictive values were 79.2% (19/24) and 69.7% (23/33), respectively. This novel predictive scoring system is potentially useful for distinguishing SM bacteremia from PA bacteremia, which would facilitate immediate administration of appropriate antimicrobial therapy.

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Data Availability

The data that support the findings of this study are available from the corresponding author on reasonable request.

Abbreviations

SM:

Stenotrophomonas maltophilia

SMX-TMP:

Sulfamethoxazole-trimethoprim

PA:

Pseudomonas aeruginosa

ROC:

Receiver operating characteristic

AUC:

Area under the ROC curve

PCP:

Pneumocystis jirovecii Pneumonia

CVC:

Central venous catheter

MALDI TOF-MS:

Matrix-assisted laser desorption ionization-time of flight mass spectrometry

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Acknowledgements

The authors thank Dr. Masayuki Yamanouchi and Dr. Junichi Hoshino (Nephrology Center, Toranomon Hospital, Japan) for randomizing the data and giving valuable comments on the statistical analysis.

Funding

This work was supported in part by a Research Grant from Okinaka Memorial Institute for Medical Research, Tokyo, Japan.

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Authors and Affiliations

  1. Department of Infectious Diseases, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan

    Takashi Sakoh, Muneyoshi Kimura, Sho Ogura, Masayo Morishima, Ryosuke Yamamuro & Hideki Araoka

  2. Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan

    Shinsuke Takagi, Kyosuke Yamaguchi, Mitsuhiro Yuasa, Daisuke Kaji, Kosei Kageyama, Yuki Taya, Aya Nishida, Kazuya Ishiwata, Hisashi Yamamoto, Go Yamamoto, Yuki Asano-Mori, Atsushi Wake, Naoyuki Uchida & Shuichi Taniguchi

  3. Okinaka Memorial Institute for Medical Research, Tokyo, Japan

    Shuichi Taniguchi & Hideki Araoka

Authors
  1. Takashi Sakoh
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  2. Muneyoshi Kimura
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  19. Shuichi Taniguchi
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  20. Hideki Araoka
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Contributions

Study conception: All authors.

Study design: Takashi Sakoh, Muneyoshi Kimura, Hideki Araoka.

Data collection: Takashi Sakoh.

Data analysis: Takashi Sakoh, Muneyoshi Kimura.

Investigation: all authors.

Writing (first draft): Takashi Sakoh, Muneyoshi Kimura, Hideki Araoka.

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hideki Araoka.

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Ethics approval

This study was approved by the ethics committee of Toranomon Hospital (approval number #1917, 2019/11/27).

Competing interests

The authors declare no competing interests.

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Sakoh, T., Kimura, M., Takagi, S. et al. Predictive scoring system for distinguishing Stenotrophomonas maltophilia bacteremia from Pseudomonas aeruginosa bacteremia in patients with hematological malignancies. Ann Hematol 102, 1239–1246 (2023). https://doi.org/10.1007/s00277-023-05185-7

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  • DOI: https://doi.org/10.1007/s00277-023-05185-7

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