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. 2017 Sep 22;17(1):638.
doi: 10.1186/s12879-017-2745-6.

Predictive implications of albumin and C-reactive protein for progression to pneumonia and poor prognosis in Stenotrophomonas maltophilia bacteremia following allogeneic hematopoietic stem cell transplantation

Kaito Harada  1 , Noritaka Sekiya  2 , Tatsuya Konishi  1 , Akihito Nagata  1 , Yuta Yamada  1 , Toshiaki Takezaki  1 , Satoshi Kaito  1 , Shuhei Kurosawa  1 , Masahiro Sakaguchi  1 , Shunichiro Yasuda  1 , Shugo Sasaki  3 , Kosuke Yoshioka  1 , Kyoko Watakabe-Inamoto  1 , Aiko Igarashi  1 , Yuho Najima  1 , Takeshi Hagino  1 , Hideharu Muto  1 , Takeshi Kobayashi  1 , Noriko Doki  1 , Kazuhiko Kakihana  1 , Hisashi Sakamaki  1 , Kazuteru Ohashi  1
Affiliations

Predictive implications of albumin and C-reactive protein for progression to pneumonia and poor prognosis in Stenotrophomonas maltophilia bacteremia following allogeneic hematopoietic stem cell transplantation

Kaito Harada et al. BMC Infect Dis. .

Abstract

Background: Stenotrophomonas maltophilia (S. maltophilia) bacteremia causes significant morbidity and mortality in immunocompromised hosts. However, incidence and risk factors for mortality in S. maltophilia bacteremia following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain controversial. The primary aim of this study is to clarify factors associated with poor prognosis of allo-HSCT recipients with S. maltophilia bacteremia.

Methods: From January 2005 to December 2014, patients with hematological diseases and S. maltophilia bacteremia at a single transplantation center in Japan were examined for incidence and 90-day mortality. Prognostic factors associated with 90-day mortality among allo-HSCT recipients were analyzed by log-rank test, and significant variables in the univariate analysis were included in the multivariate Cox proportional-hazards regression model.

Results: A total of 65 patients, including 47 patients undergoing allo-HSCT, developed S. maltophilia bacteremia. The incidence of S. maltophilia bacteremia was significantly higher in allo-HSCT recipients compared to patients not receiving allo-HSCT (6.53 vs. 0.36 per 100 admissions, respectively; p < 0.01). The overall 90-day mortality in allo-HSCT recipients was 43%. Independent risk factors for 90-day mortality were low serum albumin (<3.0 g/dl) (HR = 10.86; 95% CI, 3.27-36.12) and high serum C-reactive protein (CRP) (≥10.0 mg/dl) (HR = 3.28; 95% CI, 1.00-10.72). Among 9 patients with both high CRP and low albumin, 5 had pneumonia at the onset of bacteremia and the remaining 4 patients developed pneumonia in a median of 3 days (range, 1 to 8 days) even under effective treatment. All 9 patients eventually died in a median of 2 days (range, 2 to 32 days). The probabilities of developing pneumonia in patients with or without high CRP and low albumin levels were 100% (9/9) and 10.5% (4/38), respectively (p < 0.01).

Conclusions: Allo-HSCT recipients had higher rates of S. maltophilia bacteremia than did patients not receiving allo-HSCT. High serum CRP and low serum albumin at the onset of bacteremia are predictive of disease progression to pneumonia and poor prognosis.

Keywords: Albumin; C-reactive protein; Hematopoietic stem cell transplantation; Stenotrophomonas maltophilia.

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Conflict of interest statement

Ethics approval and consent to participate

The Ethics Review Committee at the Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital approved this study. Informed consent is not required for this type of retrospective study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Cases and incidence of S. maltophilia bacteremia in Komagome Hospital patients with hematological diseases from 2005 to 2014
Fig. 2
Fig. 2
Overall (a) and S. maltophilia-related mortality (b) in allo-HSCT recipients or in patients not receiving allo-HSCT. A vertical line (|) indicates censoring from the analysis
Fig. 3
Fig. 3
Overall mortality in allo-HSCT recipients stratified by the levels of serum albumin (a) and CRP (b) at the onset of bacteremia
See this image and copyright information in PMC

References

    1. Denton M, Kerr KG. Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia. Clin Microbiol Rev. 1998;11:57–80. - PMC - PubMed
    1. Brooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clin Microbiol Rev. 2012;25:2–41. doi: 10.1128/CMR.00019-11. - DOI - PMC - PubMed
    1. Al-Anazi KA, Al-Jasser AM. Infections caused by Stenotrophomonas maltophilia in recipients of hematopoietic stem cell transplantation. Front Oncol. 2014;4:232. - PMC - PubMed
    1. Safdar A, Rolston KV. Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer. Clin Infect Dis. 2007;45:1602–1609. doi: 10.1086/522998. - DOI - PubMed
    1. Chaplow R, Palmer B, Heyderman R, Moppett J, Marks DI. Stenotrophomonas maltophilia bacteraemia in 40 haematology patients: risk factors, therapy and outcome. Bone Marrow Transplant. 2010;45:1109–10. - PubMed

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