Kim Si-Ho, Cho Sun Young, Kang Cheol-In, Seok Hyeri, Huh Kyungmin, Ha Young Eun, Chung Doo Ryeon, Lee Nam Yong, Peck Kyong Ran, Song Jae-Hoon
Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, (06351) 81 Irwon-ro, Gangnam-gu, Seoul, South Korea.
Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Ann Hematol. 2018 Feb;97(2):343-350. doi: 10.1007/s00277-017-3178-4. Epub 2017 Nov 14.
Stenotrophomonas maltophilia (SM) has emerged as an important nosocomial pathogen with high morbidity and mortality. Because of its unique antimicrobial susceptibility pattern, appropriate antimicrobial therapy for SM bacteremia is still challenging, especially in immunocompromised patients. The present study was performed to assess clinical predictors of SM bacteremia in adult patients with hematologic malignancy. From 2006 through 2016, a case-control study was performed at a tertiary-care hospital. Case patients were defined as SM bacteremia in patients with hematologic malignancy. Date- and location-matched controls were selected from among patients with gram-negative bacteremia (GNB) other than SM. A total of 118 cases of SM bacteremia were identified and compared to 118 controls. While pneumonia was the most common source of SM bacteremia, centralline-associated infection was most common in the controls. The overall 30-day mortality rate of cases with SM bacteremia was significantly higher than that of the controls (61.0 and 32.2%, respectively; P < 0.001). A multivariable analysis showed that polymicrobial infection, previous SM isolation, the number of antibiotics previously used ≥ 3, and breakthrough bacteremia during carbapenem therapy were significantly associated with SM bacteremia (all P < 0.01). Previous use of trimethoprim/sulfamethoxazole (TMP/SMX) was negatively association with SM bacteremia (P = 0.002). Our data suggest that SM is becoming a significant pathogen in patients with hematologic malignancy. Several clinical predictors of SM bacteremia can be used for appropriate antimicrobial therapy in hematologic patients with suspected GNB.
嗜麦芽窄食单胞菌（SM）已成为一种重要的医院感染病原体，具有高发病率和死亡率。由于其独特的抗菌药物敏感性模式，针对SM菌血症的适当抗菌治疗仍然具有挑战性，尤其是在免疫功能低下的患者中。本研究旨在评估血液系统恶性肿瘤成年患者中SM菌血症的临床预测因素。2006年至2016年期间，在一家三级医疗中心进行了一项病例对照研究。病例患者定义为血液系统恶性肿瘤患者发生的SM菌血症。从除SM以外的革兰阴性菌血症（GNB）患者中选择日期和地点匹配的对照。共确定了118例SM菌血症病例，并与118例对照进行比较。虽然肺炎是SM菌血症最常见的来源，但中心静脉导管相关感染在对照组中最为常见。SM菌血症病例的总体30天死亡率显著高于对照组（分别为61.0%和32.2%；P < 0.001）。多变量分析显示，多重微生物感染、既往有SM分离史、既往使用抗生素数量≥3种以及碳青霉烯类治疗期间发生的突破性菌血症与SM菌血症显著相关（所有P < 0.01）。既往使用甲氧苄啶/磺胺甲恶唑（TMP/SMX）与SM菌血症呈负相关（P = 0.002）。我们的数据表明，SM正在成为血液系统恶性肿瘤患者中的一种重要病原体。SM菌血症的几个临床预测因素可用于对疑似GNB的血液系统患者进行适当的抗菌治疗。
