Clinical Characteristics of Rapidly Progressive Fatal Hemorrhagic Pneumonia Caused by <i>Stenotrophomonas maltophilia</i>

Abstract

Objective Hemorrhagic pneumonia due to Stenotrophomonas maltophilia (SM) in severely immunocompromised patients has a very poor prognosis. However, the risk factors for hemorrhagic pneumonia are not clear. Methods This study assessed the predictive factors of hemorrhagic pneumonia caused by SM. The medical records of patients admitted to Osaka City University Hospital with SM bacteremia between January 2008 and December 2017 were retrospectively reviewed. Patients All patients who had positive blood cultures for SM were included in this study. They were categorized into two groups: the SM bacteremia with hemorrhagic pneumonia group and the SM bacteremia without hemorrhagic pneumonia group. The clinical background characteristics and treatments were compared between these groups. Results The 35 patients with SM bacteremia included 4 with hemorrhagic pneumonia and 31 without hemorrhagic pneumonia. Hematologic malignancy (p=0.03) and thrombocytopenia (p=0.04) as well as the prior use of quinolone within 30 days (p=0.04) were more frequent in the SM bacteremia patients with hemorrhagic pneumonia than in those without hemorrhagic pneumonia. The mortality of the SM bacteremia patients with hemorrhagic pneumonia was higher than that of those without hemorrhagic pneumonia group (p= 0.02). Conclusion Patients with SM bacteremia who have hematologic malignancy, thrombocytopenia, and a history of using quinolone within the past 30 days should be treated with deliberation.

Fatal hemorrhagic pneumonia in patients with hematologic diseases and Stenotrophomonas maltophilia bacteremia: a retrospective study

“…In the present study, the overall mortality rate of SM bacteremia in patients with hematologic diseases was 67.3%, which was comparable to that obtained in past studies, ranging from 35-75% [8][9][10][11][12]. The mortality rate of SM bacteremia with hemorrhagic pneumonia was signi cantly higher than those without hemorrhagic pneumonia.…”

“…Due to the intrinsic resistance of SM to many broad-spectrum antimicrobial agents, it is di cult to determine the appropriate antibiotic treatment before the SM is detected [2,7]. Therefore, previous studies have shown a very poor prognosis in the cases of SM bacteremia, and the overall mortality was ranged from 35 to 75% [8][9][10][11][12]. Noteworthy, in patients with hematologic malignancies and/or hematopoietic stem cell transplantation (HSCT) recipients, SM can cause fatal hemorrhagic pneumonia, and the mortality is nearly 100% [10,[12][13][14][15][16][17].…”

“…Therefore, previous studies have shown a very poor prognosis in the cases of SM bacteremia, and the overall mortality was ranged from 35 to 75% [8][9][10][11][12]. Noteworthy, in patients with hematologic malignancies and/or hematopoietic stem cell transplantation (HSCT) recipients, SM can cause fatal hemorrhagic pneumonia, and the mortality is nearly 100% [10,[12][13][14][15][16][17]. At present, only a few reports have performed a statistical analysis to identify the risk factors of hemorrhagic pneumonia caused by SM [10,12].…”

Successful treatment of pulmonary haemorrhage and acute respiratory distress syndrome caused by fulminant Stenotrophomonas maltophilia respiratory infection in a patient with acute lymphoblastic leukaemia – case report

“…The pulmonary haemorrhage caused by Stenotrophomonas maltophilia is a rare condition with a poor outcome. Several reports have shown the presence of predisposing factors like severe thrombocytopenia, severe and prolonged neutropenia, the previous use of quinolones, corticosteroids, and immunosuppressive therapy [2,8,9]. Our patient had grade IV thrombocytopenia and neutropenia secondary to chemotherapy.…”

“…In the published literature, we found 34 haematological patients with Stenotrophomonas maltophilia and pulmonary haemorrhage [2,8]. Most patients (22 out of 34) were diagnosed with acute myeloid leukaemia, and the mortality rate was 100%, and the survival length was 0-43 days.…”