Harada K, et al. - Authors here aimed at assessing factors associated with poor prognosis of allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients with Stenotrophomonas maltophilia (S. maltophilia) bacteremia. Findings revealed higher rates of S. maltophilia bacteremia among allo-HSCT recipients than patients not receiving allo-HSCT. In this study, high serum C-reactive protein (CRP) and low serum albumin at the onset of bacteremia proved predictive of disease progression to pneumonia and poor prognosis.

Methods

• Authors examined patients with hematological diseases and S. maltophilia bacteremia for incidence and 90-day mortality in Japan from January 2005 to December 2014 .
• They performed analysis of prognostic factors associated with 90-day mortality among allo-HSCT recipients by log-rank test.
• Significant variables in the univariate analysis were included in the multivariate Cox proportional-hazards regression model.

Results

• In this study, a total of 65 patients, including 47 patients undergoing allo-HSCT, developed S. maltophilia bacteremia.
• Significantly higher incidence of S. maltophilia bacteremia was observed in allo-HSCT recipients compared to patients not receiving allo-HSCT (6.53 vs. 0.36 per 100 admissions, respectively; p < 0.01).
• In allo-HSCT recipients, findings revealed an overall 90-day mortality of 43%.
• For 90-day mortality, independent risk factors included 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 indicated 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.
• In a median period of 2 days (range, 2 to 32 days), all 9 patients eventually died.
• In patients with or without high CRP and low albumin levels, the probabilities of developing pneumonia were 100% (9/9) and 10.5% (4/38), respectively (p < 0.01).