Stenotrophomonas maltophilia infection in hematopoietic SCT recipients: high mortality due to pulmonary hemorrhage

Abstract

To clarify the clinical features and outcome of Stenotrophomonas maltophilia infection among hematopoietic SCT (HCT) recipients, we retrospectively reviewed the records of 1085 consecutive HCT recipients and identified 42 episodes in 31 HCT recipients with S. maltophilia infection. We compared these recipients with 30 non-HCT patients with S. maltophilia infection. The mortality rate in HCT recipients was significantly higher than that in non-HCT patients (relative risk 5.7, P ¼ 0.04), and we identified seven patients with pulmonary hemorrhage due to S. maltophilia, exclusively in the HCT cohort. Six of these latter seven patients died within 1 day from the onset of hemorrhage and the isolate was identified after death in most cases; one patient, who received empiric therapy for S. maltophilia and granulocyte transfusion, survived for more than 2 weeks. The patients with pulmonary hemorrhage had a more severe and longer duration of neutropenia, persistent fever despite of the use of broad-spectrum antibiotics, complication by pneumonia and higher C-reactive protein levels than those without pulmonary hemorrhage. In conclusion, S. maltophilia was associated with fulminant and fatal pulmonary hemorrhage in HCT recipients. Empiric therapy with antibiotics before the onset of pulmonary hemorrhage may be effective in HCT recipients who carry the conditions identified.

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

“…S. maltophilia causes various infectious complications in immunocompromised individuals and these include bacteremia, endocarditis, respiratory tract infections, meningitis, urinary tract infections, skin and soft tissue infections, mastoiditis, bone and joint infections, peritonitis, typhlitis and biliary sepsis, wound infections, and central venous catheter (CVC)-related infections (1–3, 5–7, 11, 15–17). Occasionally, distinguishing between colonization and infection can be problematic (1–3).…”

Diffuse Alveolar Hemorrhage in Acute Myeloid Leukemia

“…Systemic high-dose steroids are typically recommended for noninfectious cases of DAH to combat the inflammation precipitated by the underlying disease process. 9 However, research has not shown significant differences in rates of mortality between patients with DAH receiving low-, medium-, or high-dose steroids. 9 Use of platelet transfusions to treat thrombocytopenia in the setting of hemorrhage is widely accepted, but further research is necessary for the use of other treatments such as aminocaproic acid and activated factor VII.…”

“…9 However, research has not shown significant differences in rates of mortality between patients with DAH receiving low-, medium-, or high-dose steroids. 9 Use of platelet transfusions to treat thrombocytopenia in the setting of hemorrhage is widely accepted, but further research is necessary for the use of other treatments such as aminocaproic acid and activated factor VII. Although initial study results have suggested a benefit to using aminocaproic acid in addition to steroids to treat DAH in patients who had received allogeneic HSCT, subsequent research has showed no benefit.…”

“…Although initial study results have suggested a benefit to using aminocaproic acid in addition to steroids to treat DAH in patients who had received allogeneic HSCT, subsequent research has showed no benefit. 9 Prior case reports and research have shown that use of factor VII can control bleeding in the set- ting of DAH, but the cost can be restrictive in patients whose underlying disease remains grim. 10 Use of factor VII must also be weighed against the risk of thrombosis, and clinicians should use it with caution or avoid it altogether in patients who have had recent surgery or have a history of thrombosis, liver disease, myocardial infarction, or stroke.…”

“…2 Table 2 lists the infectious causes of DAH. [9][10][11][12][13][14][15][16][17][18][19][20] It is important that clinicians remember that DAH can disguise itself in areas of infection as well as infarction. 2 As reflected in our case series, it seems reasonable to consider empirical antibiotic coverage while establishing a diagnosis.…”