Stenotrophomonas maltophilia Infections in Haematological Malignancies and Hematopoietic Stem Cell Transplantation: A Case Series including Cefiderocol-Based Regimens

Author:

Lupia Tommaso1ORCID,Carnevale-Schianca Fabrizio2,Vita Davide3ORCID,Busca Alessandro4ORCID,Caravelli Daniela2,Crisà Elena2,Gregorc Vanesa2,Curtoni Antonio5ORCID,Cerutti Alessandro6,Shbaklo Nour3,Corcione Silvia37,De Rosa Francesco Giuseppe13ORCID

Affiliation:

1. Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy

2. Unit of Oncology and Haematology, Candiolo Cancer Institute, FPO-IRCCS Strada Provinciale 142, 10060 Candiolo, Italy

3. Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy

4. Department of Oncology, Stem Cell Transplant Center, Città della Salute e della Scienza Hospital, 10100 Turin, Italy

5. Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, 10100 Turin, Italy

6. Intensive Care Unit, IRCCS Candiolo, 10100 Candiolo, Italy

7. School of Medicine, Tufts University, Boston, MA 02111, USA

Abstract

Background and Objectives: Stenotrophomonas maltophilia is a ubiquitous, aerobic, Gram-negative bacillus causing increasing concern in patients affected by haematological malignancies. Materials and Methods: We report a case series from two centres in Northern Italy to describe the characteristics, outcome and microbiological response of S. maltophilia infections in patients with haematological malignancies and/or allogenic hematopoietic stem cell transplantation (aHSCT). Results: Ten patients were included. The median age was 67 years, and seven patients (70%) were males. The median Charlson Comorbidity Index was 6 (IQR: 4–8). The most frequent haematological comorbidities were acute myeloid leukaemia (AML; n = 3; 30%) and non-Hodgkin’s lymphoma (n = 3; 30%). Three (30%) patients underwent aHSCT before infection, all for AML. All the patients had undergone a recent antibiotics course and had an indwelling central venous catheter before infection. The main clinical presentations were nosocomial pneumonia, with (2; 20%) or without (4; 40%) secondary bloodstream infection and CRBSI (3; 30%). Four patients were treated with cefiderocol in monotherapy or combinations therapy with cotrimoxazole. The rest of the patients were treated with cotrimoxazole or levofloxacin in monotherapy. Conclusions: Despite a high rate of clinical improvement (90%) after starting antimicrobial therapy, we faced high 30-day mortality (30%) and in-hospital mortality (50%) rates in a highly comorbid population.

Funder

EU funding

Publisher

MDPI AG

Reference40 articles.

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2. Stenotrophomonas maltophilia: An Emerging Global Opportunistic Pathogen;Brooke;Clin. Microbiol. Rev.,2012

3. Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies;Micozzi;Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am.,2000

4. Stenotrophomonas maltophilia bacteremia and pneumonia at a tertiary-care oncology center: A review of 16 years;Support. Care Cancer Off. J. Multinatl. Assoc. Support. Care Cancer,2018

5. Pathogenic significance of hemorrhagic pneumonia in hematologic malignancy patients with Stenotrophomonas maltophilia bacteremia: Clinical microbiological analysis;Kim;Eur. J. Clin. Microbiol. Infect. Dis. Off. Publ. Eur. Soc. Clin. Microbiol.,2019

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