Department of Pharmacy, Barnes Jewish Hospital, 216 S. Kingshighway Blvd, Mailstop 90-52-41, Saint Louis, MO, 63110, USA.
Department of Pharmacy, SSM-Health St. Louis University Hospital, Saint Louis, MO, USA.
Ann Hematol. 2024 May;103(5):1745-1752. doi: 10.1007/s00277-024-05686-z. Epub 2024 Mar 8.
Stenotrophomonas maltophilia (SM) bloodstream infections (BSIs) contribute to significant mortality in hematologic malignancy (HM) and hematopoietic stem cell transplantation (HSCT) patients. A risk score to predict SM BSI could reduce time to appropriate antimicrobial therapy (TTAT) and improve patient outcomes. A single center cohort study of hospitalized adults with HM/HSCT was conducted. Patients had ≥ 1 blood culture with a Gram-negative (GN) organism. A StenoSCORE was calculated for each patient. The StenoSCORE2 was developed using risk factors for SM BSI identified via logistic regression. Receiver operating characteristic (ROC) curves were plotted. Sensitivity and specificity for the StenoSCORE and StenoSCORE2 were calculated. Thirty-six SM patients and 534 non-SM patients were assessed. A StenoSCORE ≥ 33 points was 80% sensitive, 68% specific, and accurately classified 69% of GN BSIs. StenoSCORE2 variables included acute leukemia, prolonged neutropenia, mucositis, ICU admission, recent meropenem and/or cefepime exposure. The StenoSCORE2 performed better than the StenoSCORE (ROC AUC 0.84 vs. 0.77). A StenoSCORE2 ≥ 4 points was 86% sensitive, 76% specific, and accurately classified 77% of GN BSIs. TTAT was significantly longer for patients with SM BSI compared with non-SM BSI (45.16 h vs. 0.57 h; p < 0.0001). In-hospital and 28-day mortality were significantly higher for patients with SM BSI compared to non-SM BSI (58.3% vs. 18.5% and 66.7% vs. 26.4%; p-value < 0.0001). The StenoSCORE and StenoSCORE2 performed well in predicting SM BSIs in patients with HM/HSCT and GN BSI. Clinical studies evaluating whether StenoSCORE and/or StenoSCORE2 implementation improves TTAT and clinical outcomes are warranted.
嗜麦芽窄食单胞菌（SM）血流感染（BSI）导致血液恶性肿瘤（HM）和造血干细胞移植（HSCT）患者的死亡率显著增加。预测 SM BSI 的风险评分可以减少获得适当抗菌治疗的时间（TTAT）并改善患者预后。对住院 HM/HSCT 成年患者进行了单中心队列研究。患者有≥1 次血培养革兰氏阴性（GN）菌阳性。为每位患者计算了 StenoSCORE。通过逻辑回归确定 SM BSI 的危险因素，开发了 StenoSCORE2。绘制了接收者操作特征（ROC）曲线。计算了 StenoSCORE 和 StenoSCORE2 的敏感性和特异性。评估了 36 例 SM 患者和 534 例非 SM 患者。StenoSCORE≥33 分的患者敏感性为 80%，特异性为 68%，对 69%的 GN BSI 准确分类。StenoSCORE2 变量包括急性白血病、中性粒细胞减少时间延长、黏膜炎、入住 ICU、近期使用美罗培南和/或头孢吡肟。StenoSCORE2 优于 StenoSCORE（ROC AUC 0.84 与 0.77）。StenoSCORE2≥4 分的患者敏感性为 86%，特异性为 76%，对 77%的 GN BSI 准确分类。与非 SM BSI 相比，SM BSI 患者的 TTAT 明显更长（45.16 小时比 0.57 小时；p<0.0001）。与非 SM BSI 相比，SM BSI 患者的住院和 28 天死亡率明显更高（58.3%比 18.5%和 66.7%比 26.4%；p 值<0.0001）。StenoSCORE 和 StenoSCORE2 可用于预测 HM/HSCT 和 GN BSI 患者的 SM BSI。需要进行临床研究评估 StenoSCORE 和/或 StenoSCORE2 的实施是否可以改善 TTAT 和临床结局。
