© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Clin Transplant 2014: 28: 656–661 DOI: 10.1111/ctr.12356

Clinical Transplantation

Stenotrophomonas maltophilia infection during allogeneic hematopoietic stem cell transplantation: a single-center experience Shiratori S, Wakasa K, Okada K, Sugita J, Akizawa K, Shigematsu A, Hashimoto D, Fujimoto K, Endo T, Kondo T, Shimizu C, Hashino S, Teshima T. Stenotrophomonas maltophilia infection during allogeneic hematopoietic stem cell transplantation: a single-center experience. Abstract: To examine risk factors for Stenotrophomonas maltophilia (S. maltophilia) infection during allogeneic hematopoietic stem cell transplantation (allo-HSCT), we retrospectively analyzed 259 patients who underwent allo-HSCT. Not only S. maltophilia infection but also S. maltophilia colonization was associated with mortality during alloHSCT. Among 52 episodes in 39 patients in whom S. maltophilia was detected, documented infection developed in 33 episodes (25 patients). The onset of S. maltophilia infection in the period from the conditioning regimen to engraftment was associated with a high mortality rate. Breakthrough S. maltophilia infection developed in 24% of the patients during prophylactic administration of fluoroquinolones, to which S. maltophilia is sensitive. Reinsertion of a central venous catheter (CVC) immediately after removal was suggested to be a risk for persistent S. maltophilia infection in the period of neutropenia. Our results indicated that (i) onset of S. maltophilia infection in the period from the conditioning therapy to engraftment and (ii) removal and immediate reinsertion of a CVC as treatment after the onset of S. maltophilia infection are possible risk factors for S. maltophilia-related mortality during allo-HSCT.

Souichi Shiratoria, Kentaro Wakasab, Kohei Okadaa, Junichi Sugitaa, Koji Akizawac, Akio Shigematsua,c, Daigo Hashimotoa, Katsuya Fujimotoa, Tomoyuki Endoa, Takeshi Kondoa, Chikara Shimizuc, Satoshi Hashinoa and Takanori Teshimaa a

Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, bDepartment of Internal Medicine, Obihiro-Kosei General Hospital, Obihiro, and c Department of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan Key words: allogeneic hematopoietic stem cell transplantation – bacterial infection – central venous catheter – neutropenia – Stenotrophomonas maltophilia Corresponding author: Souichi Shiratori, MD, Department of Hematology, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. Tel.: +81 11 706 7214; fax: +81 11 706 7823; e-mail: [email protected] Conflict of interest: None. Accepted for publication 26 February 2014

Stenotrophomonas maltophilia (S. maltophilia) is a glucose non-fermentative Gram-negative bacillus that can be isolated from humectant environments (1–4). Stenotrophomonas maltophilia has multiantibiotic resistance because of the natural possession of metallo-b-lactamase and cephalosporinase (5). Community-acquired S. maltophilia infection is rare; however, under some risk conditions including a compromised health status (6, 7), indwelling central venous catheter (CVC) or ventilation tube (6, 8–13), exposure to broad-spectrum antibiotics (6, 11, 14), intensive care unit (ICU) stay (6, 7, 9, 12, 14, 15), and long-term hospitaliza-

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tion (16), S. maltophilia infection can develop as severe bloodstream infection or pneumonia. Several previous studies have shown clinical characteristics and risk factors of S. maltophilia infection in patients with hematologic diseases after chemotherapy (17–22) and allogeneic hematopoietic stem cell transplantation (allo-HSCT) (4, 23–26), but the details are not fully understood. In this study, we retrospectively analyzed clinical characteristics of S. maltophilia infection in patients with hematologic diseases who underwent allo-HSCT, and some possible risk factors for S. maltophilia infection were indicated.

S. maltophilia infection during allo-HSCT Patients and methods Data collection

Medical charts of 259 patients with hematologic diseases who underwent allo-HSCT between January 2004 and December 2011 in Hokkaido University were reviewed to identify episodes of S. maltophilia infection during admission. Clinical features and outcomes in this cohort were then investigated. Definitions and microbiology

Stenotrophomonas maltophilia blood stream infection (BSI) was defined as one or more positive blood cultures for S. maltophilia with documented signs of infection. Stenotrophomonas maltophilia infections other than BSI were defined as invasive when S. maltophilia was isolated from cultures in the presence of both clinical symptoms and signs of infection. The period of an S. maltophilia “infection episode” was defined as the day of collection of S. maltophilia culture-positive samples to the end (improvement or death) of infection. Improvement of S. maltophilia infection was defined as a response to therapy on the basis of decreasing fever (

Stenotrophomonas maltophilia infection during allogeneic hematopoietic stem cell transplantation: a single-center experience.

To examine risk factors for Stenotrophomonas maltophilia (S. maltophilia) infection during allogeneic hematopoietic stem cell transplantation (allo-HS...
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