Stenotrophomonas maltophilia infection during allogeneic hematopoietic stem cell transplantation: a single‐center experience

Abstract

To examine risk factors for Stenotrophomonas maltophilia (S. maltophilia) infection during allogeneic hematopoietic stem cell transplantation (allo-HSCT), we retrospectively analyzed 259 patients who underwent allo-HSCT. Not only S. maltophilia infection but also S. maltophilia colonization was associated with mortality during allo-HSCT. Among 52 episodes in 39 patients in whom S. maltophilia was detected, documented infection developed in 33 episodes (25 patients). The onset of S. maltophilia infection in the period from the conditioning regimen to engraftment was associated with a high mortality rate. Breakthrough S. maltophilia infection developed in 24% of the patients during prophylactic administration of fluoroquinolones, to which S. maltophilia is sensitive. Reinsertion of a central venous catheter (CVC) immediately after removal was suggested to be a risk for persistent S. maltophilia infection in the period of neutropenia. Our results indicated that (i) onset of S. maltophilia infection in the period from the conditioning therapy to engraftment and (ii) removal and immediate reinsertion of a CVC as treatment after the onset of S. maltophilia infection are possible risk factors for S. maltophilia-related mortality during allo-HSCT.

Stenotrophomonas maltophilia colonization during allogeneic hematopoietic stem cell transplantation is associated with impaired survival

“…The colonization rate of 6.9% (20 patients) is comparable to other studies: Shiratori et al reported from a colonization rate of 6.4% (14/220 patients)[ 31 ]. In our study, colonized patients revealed in our study a significant lower OS in univariate analysis as well as in multivariate analysis (HR 1.982, 95% CI 1.091–3.597; p = 0.025) due to a higher NRM compared to non-colonized patients (5-year cumulative incidence of NRM: 40.1% vs. 16.2%, p = 0.003).…”

Central venous catheter‐related blood stream infection with pyomyositis due to Stenotrophomonas maltophilia after allogeneic bone marrow transplantation in a patient with aplastic anemia

“…Yeshurun et al reported that 19 of 570 patients undergoing HSCT had invasive S. maltophilia infection and six died of infection. Shiratori et al reported that 25 of 259 patients undergoing HSCT had S. maltophilia infection and four died of septic shock or pneumonia.…”

“…Stenotrophomonas maltophilia causes serious infectious complications in HSCT patients . Pyomyositis is a purulent infection of skeletal muscle that arises from hematogenous spread, usually with abscess formation .…”

Infections Caused by Stenotrophomonas maltophilia in Recipients of Hematopoietic Stem Cell Transplantation

“…In recipients of HSCT, the risk factors for hospital-acquired pneumonia due to S. maltophilia include: (1) immunocompromised health status, (2) indwelling CVCs, (3) mechanical ventilation, (4) exposure to and duration of broad-spectrum antibiotic therapy, (5) prolonged hospitalization, (6) admission to an intensive care unit (ICU), and (7) presence of underlying lung disease such as chronic obstructive airway disease (25, 26). Treatment of ventilator-associated pneumonia (VAP) caused by S. maltophilia includes: (1) high dose trimethoprim-sulfamethoxazole (TMP-SMZ), which is still considered the drug of choice based on its excellent in vitro activity, and (2) an alternative antimicrobial therapy in patients having drug resistance, allergy, or adverse effects related to TMP-SMZ that includes a new fluoroquinolone or a combination of doxycycline and aerosolized colistin (27, 28).…”