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. 2021 May 4;72(9):1507-1513.
doi: 10.1093/cid/ciaa778.

Alterations of the Oral Microbiome and Cumulative Carbapenem Exposure Are Associated With Stenotrophomonas maltophilia Infection in Patients With Acute Myeloid Leukemia Receiving Chemotherapy

Samuel L Aitken  1   2 , Pranoti V Sahasrabhojane  3 , Dimitrios P Kontoyiannis  2   3 , Tor C Savidge  4   5 , Cesar A Arias  2   6 , Nadim J Ajami  2   7 , Samuel A Shelburne  2   3   7 , Jessica R Galloway-Peña  2   3   7
Affiliations

Alterations of the Oral Microbiome and Cumulative Carbapenem Exposure Are Associated With Stenotrophomonas maltophilia Infection in Patients With Acute Myeloid Leukemia Receiving Chemotherapy

Samuel L Aitken et al. Clin Infect Dis. .

Abstract

Background: Stenotrophomonas maltophilia is increasingly common in patients with acute myeloid leukemia (AML). Little is known about factors that drive S. maltophilia infection. We evaluated the microbiome and cumulative antibiotic use as predictors of S. maltophilia infection in AML patients receiving remission induction chemotherapy (RIC).

Methods: Subanalysis of a prospective, observational cohort of patients with AML receiving RIC between September 2013 and August 2015 was performed. Fecal and oral microbiome samples collected from initiation of RIC until neutrophil recovery were assessed for the relative abundance of Stenotrophomonas via 16S rRNA gene quantitation. The primary outcome, microbiologically proven S. maltophilia infection, was analyzed using a time-varying Cox proportional hazards model.

Results: Of 90 included patients, 8 (9%) developed S. maltophilia infection (pneumonia, n = 6; skin-soft tissue, n = 2); 4/8 (50%) patients were bacteremic; and 7/8 (88%) patients with S. maltophilia infection had detectable levels of Stenotrophomonas vs 22/82 (27%) without infection (P < .01). An oral Stenotrophomonas relative abundance of 36% predicted infection (sensitivity, 96%; specificity, 93%). No association of S. maltophilia infection with fecal relative abundance was found. Cumulative meropenem exposure was associated with increased infection risk (hazard ratio, 1.17; 95% confidence interval, 1.01-1.35; P = .03).

Conclusions: Here, we identify the oral microbiome as a potential source for S. maltophilia infection and highlight cumulative carbapenem use as a risk factor for S. maltophilia in leukemia patients. These data suggest that real-time monitoring of the oral cavity might identify patients at risk for S. maltophilia infection.

Keywords: bacteremia; colonization; meropenem; pneumonia; risk factors.

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Figures

Figure 1.
Figure 1.
Relative abundance of Stenotrophomonas in patients with and without Stenotrophomonas maltophilia infection. All lines originate at the time of first sampling and end at the end of the risk period (time of S. maltophilia infection or neutrophil recovery). The x-axis is right-truncated at 30 days for clarity; 71/90 (88%) remained at 0% detectable throughout the risk period.
Figure 2.
Figure 2.
Maximum Stenotrophomonas oral abundance in patients with and without Stenotrophomonas maltophilia infection. Horizontal bars indicate median and upper and lower quartiles. Solid dots indicate outlier values, as applicable.
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