Department of Hematology, Kokura Memorial Hospital, Kitakyushu, Japan.
Ann Hematol. 2014 Jun;93(6):901-11. doi: 10.1007/s00277-014-2028-x. Epub 2014 Feb 18.
Since the late 1990s, Stenotrophomonas maltophilia (S. maltophilia) has become one of the most common nonfermenting Gram-negative bacilli that cause opportunistic infection. Patients with hematologic diseases are the most risky candidate for S. maltophilia pneumonia or sepsis because of chemotherapy-induced neutropenia or immunodeficiency. Frequent exposure to broad-spectrum antibiotics and prolonged insertion of central venous catheter further enhance the risk of S. maltophilia infection. One of the most severe S. maltophilia infections is hemorrhagic pneumonia. This type of infection is mostly fatal because of pulmonary alveolar hemorrhage that leads to acute respiratory failure. Furthermore, S. maltophilia exhibits a high-level intrinsic resistance to conventional antibiotics such as β-lactams and aminoglycosides and, more recently, the increasing acquired resistance to co-trimoxazole and quinolones. According to our experienced and previously reported cases, all of the patients with hemorrhagic pneumonia caused by S. maltophilia had a fatal course within a few days after the onset of the pneumonia. In this article, we perform a systematic review on a total 30 cases of hemorrhagic pneumonia induced by S. maltophilia from our institutions and the literature, and we describe its early diagnosis, prophylaxis, and recommended therapeutic strategy for the infection in the treatment of hematologic disease.
自 20 世纪 90 年代末以来，嗜麦芽寡养单胞菌（S. maltophilia）已成为引起机会性感染的最常见非发酵革兰氏阴性杆菌之一。由于化疗引起的中性粒细胞减少或免疫功能低下，血液系统疾病患者是嗜麦芽寡养单胞菌肺炎或败血症的高危人群。频繁接触广谱抗生素和长期插入中心静脉导管进一步增加了嗜麦芽寡养单胞菌感染的风险。嗜麦芽寡养单胞菌感染最严重的一种是出血性肺炎。这种类型的感染大多是致命的，因为肺泡出血导致急性呼吸衰竭。此外，嗜麦芽寡养单胞菌对传统抗生素（如β-内酰胺类和氨基糖苷类）表现出高水平的固有耐药性，最近对复方磺胺甲噁唑和喹诺酮类药物的获得性耐药性也在增加。根据我们的经验和之前报告的病例，所有由嗜麦芽寡养单胞菌引起的出血性肺炎患者在肺炎发病后几天内均死亡。在本文中，我们对来自我们机构和文献中的 30 例由嗜麦芽寡养单胞菌引起的出血性肺炎进行了系统回顾，并描述了其早期诊断、预防以及在血液系统疾病治疗中针对该感染的推荐治疗策略。
