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Stenotrophomonas maltophilia pneumonia in cancer patients without traditional risk factors for infection, 1997–2004

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Abstract

In order to elucidate the spectrum of Stenotrophomonas maltophilia pneumonia in cancer patients without traditional risk factors, 44 cancer patients (cases) with S. maltophilia pneumonia in whom S. maltophilia pneumonia risk factors were not present were compared with two S. maltophilia pneumonia risk groups (controls) including 43 neutropenic non-intensive care unit (ICU) and 21 non-neutropenic ICU patients. The case and control patients had similar demographic and underlying clinical characteristics. Compared with case patients with S. maltophilia pneumonia, neutropenic patients had higher exposure to carbapenem antibiotics (58 vs. 41%; p < 0.03), more frequent hematologic malignancy (95 vs. 64%; p < 0.0003), and they presented with concurrent bacteremia more often (23 vs. 0%; p < 0.0005). Patients with S. maltophilia pneumonia in the ICU needed vasopressor therapy more frequently than cases (62 vs. 5%; p < 0.0001). Hospital-acquired S. maltophilia pneumonia was more common among controls than cases (98 vs. 61%; p < 0.000002). Among the cases, 15 (34%) received outpatient oral antimicrobial therapy, while 29 were hospitalized and eight (28%) were subsequently admitted to the ICU. The mean duration of ICU stay, even among these eight patients (19 ± 40 days), was comparable to that of patients with neutropenia (23 ± 26 days) and those who developed S. maltophilia pneumonia during their ICU stay (34 ± 22 days; p = 0.46). The overall infection-associated mortality in the 108 patients with S. maltophilia pneumonia was 25%. Twenty percent of patients without traditional risk factors for S. maltophilia pneumonia died due to progressive infection. In a multivariate logistic regression analysis, only admission to the ICU predicted death (odds ratio 33; 95% confidence interval, 4.51–241.2; p < 0.0006). The results of this study indicate S. maltophilia pneumonia is a serious infection even in non-neutropenic, non-ICU patients with cancer.

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Acknowledgments

We thank Dr Jeffrey Tarrand (Department of Laboratory Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX) for providing the microbiologic information presented in the current report.

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Authors and Affiliations

  1. Department of Infectious Diseases, Infection Control, and Employee Health, Unit 402, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA

    G. Aisenberg, K. V. Rolston, D. P. Kontoyiannis, I. I. Raad & A. Safdar

  2. Department of Pulmonary Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    B. F. Dickey

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  1. G. Aisenberg
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  2. K. V. Rolston
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  3. B. F. Dickey
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  4. D. P. Kontoyiannis
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  5. I. I. Raad
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  6. A. Safdar
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Correspondence to A. Safdar.

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Aisenberg, G., Rolston, K.V., Dickey, B.F. et al. Stenotrophomonas maltophilia pneumonia in cancer patients without traditional risk factors for infection, 1997–2004. Eur J Clin Microbiol Infect Dis 26, 13–20 (2007). https://doi.org/10.1007/s10096-006-0243-7

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