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Risk Factors For Stenotrophomonas Maltophilia Bacteremia In Oncology Patients: A Case–Control Study

Published online by Cambridge University Press:  02 January 2015

Anucha Apisarnthanarak
Affiliation:
Division of Infectious Diseases, St. Louis, Missouri
Jennie L. Mayfield
Affiliation:
Infection Control Department, Barnes–Jewish Hospital, St. Louis, Missouri
Teresa Garison
Affiliation:
Infection Control Department, Barnes–Jewish Hospital, St. Louis, Missouri
Patricia M. McLendon
Affiliation:
Infection Control Department, Barnes–Jewish Hospital, St. Louis, Missouri
John F. DiPersio
Affiliation:
Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, St. Louis, Missouri
Louis B. Polish*
Affiliation:
Division of Infectious Diseases, St. Louis, Missouri
*
Washington University School of Medicine, Campus Box 8051, 660 South Euclid Ave., St. Louis, MO 63110

Abstract

Objective:

To characterize risk factors for Stenotrophomonas maltophilia bloodstream infection in oncology patients.

Design:

A 3:1 case–control study.

Setting:

Stem Cell Transplant and Leukemic Center at Barnes–Jewish Hospital (St. Louis), a 1,442-bed, tertiary-care teaching hospital with a 26-bed transplantation ward.

Method:

From June 1999 to April 2001,13 patients with S. maltophilia bacteremia were compared with 39 control-patients who were on the transplantation unit on the same day as the case-patients' positive blood cultures. Information collected included patient demographics, medical history, history of transplantation, transplantation type, graft versus host disease, neutropenia, antibiotic use, chemotherapy, mucositis, diarrhea, the presence of central venous catheter(s), cultures, and concomitant infections.

Results:

Significant risk factors for S. maltophilia bacteremia included severe mucositis (7 [53.8%] of 13 vs 8 [20.5%] of 39; P = .034), diarrhea (7 [53.8%] of 13 vs 8 [20%] of 39; P = .034), and the use of metronidazole (9 [69.2%] of 13 vs 8 [20.5%] of 39; P = .002). In addition, the number of antibiotics used (median, 9 vs 5; P < .001), duration of mucositis (median, 29 vs 15 days; P = .032), and length of hospital stay (median, 34 vs 22 days; P = .017) were significantly different between case- and control-patients. Nine S. maltophilia isolates tested by pulsed-field gel electrophoresis were found to be distinctly different.

Conclusion:

Interventions to ameliorate the severity of mucositis, reduce antibiotic pressure, prevent diarrhea, and promote meticulous central venous catheter care may help prevent S. maltophilia bloodstream infection in oncology patients. The role of gastrointestinal tract colonization as a potential source of S. maltophilia bacteremia in oncology patients deserves further investigation.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Lennette, EH, Barlow, A, Hausler, WJ, Shadomy, HJ. Manual of Clinical Microbiology. Washington, DC: American Society for Microbiology; 1985.Google Scholar
2.Micozzi, A, Venditti, M, Monaco, M, et al. Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies. Clin Infect Dis 2000;31:705711.Google Scholar
3.Verweij, PE, Meis, JF, Christmann, V, et al. Nosocomial outbreak of colonization and infection with Stenotrophomonas maltophilia in preterm infants associated with contaminated tap water. Epidemiol Infect 1998;120:251256.Google Scholar
4.Hugh, R, Ryschenkow, E. Pseudomonas maltophilia and Alcaligenes-like species. J Gen Microbiol 1961;26:123132.Google Scholar
5.Gilardi, GL. Pseudomonas maltophilia infections in man. Am J Clin Pathol 1969;51:5861.Google Scholar
6.Khardori, N, Elting, L, Wong, E, Schable, B, Bodey, GP. Nosocomial infections due to Xanthomonas maltophilia (Pseudomonas maltophilia) in patients with cancer. Rev Infect Dis 1990;12:9971003.Google Scholar
7.Victor, MA, Arpi, M, Brunn, B, Jonsson, V, Hansen, MM. Xanthomonas maltophilia bacteremia in immunocompromised hematological patients. Scand J Infect Dis 1994;26:163170.Google Scholar
8.Labarca, JA, Leber, AL, Kern, VL, et al. Outbreak of Stenotrophomonas maltophilia bacteremia in allogeneic bone marrow transplant patients: role of severe neutropenia and mucositis. Clin Infect Dis 2000;30:195197.Google Scholar
9.Diekema, DJ, Pfaller, MA, Jones, RN, et al. Survey of bloodstream infections due to gram-negative bacilli: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, and Latin America for the SENTRY Antimicrobial Surveillance Program, 1997. Clin Infect Dis 1999;29:595607.Google Scholar
10.Gales, AC, Jones, RN, Forward, KR, Linares, J, Sader, HS, Verhoef, J. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: geographic patterns, epidemiological features, and trends in the SENTRY antimicrobial surveillance program (1997-1999). Clin Infect Dis 2001;32(suppl 2):S104S113.Google Scholar
11.Marshall, WF, Keating, MR, Anhalt, JP, Steckelberg, JM. Xanthomonas maltophilia: an emerging nosocomial pathogen. Mayo Clinic Proc 1989;64:10971104.Google Scholar
12.Gilardi, GL. Infrequently encountered Pseudomonas species causing infection in humans. Ann Intern Med 1972;77:211215.Google Scholar
13.Morrison, AJ Jr, Hoffman, KK, Wenzel, RP. Associated mortality and clinical characteristics of nosocomial Pseudomonas maltophilia in a university hospital. J Clin Microbiol 1986;24:5255.Google Scholar
14.Schoch, PE, Cunha, BA. Pseudomonas maltophilia. Infect Control Hosp Epidemiol 1987;8:169172.CrossRefGoogle ScholarPubMed
15.Klausner, JD, Zukerman, C, Limaye, AP, Corey, L. Outbreak of Stenotrophomonas maltophilia bacteremia among patients undergoing bone marrow transplantation: association with faulty replacement of handwashing soap. Infect Control Hosp Epidemiol 1999;20:756758.CrossRefGoogle ScholarPubMed
16.Alfieri, N, Ramotar, K, Armstrong, P, et al. Two consecutive outbreaks of Stenotrophomonas maltophilia (Xanthomonas maltophilia) in an intensive-care unit defined by restriction fragment length polymorphism typing. Infect Control Hosp Epidemiol 1999;20:553556.CrossRefGoogle Scholar
17.Muder, RR, Harris, AP, Muller, S, et al. Bacteremia due to Stenotrophomonas (Xanthomonas) maltophilia: a prospective, multicenter study of 91 episodes. Clin Infect Dis 1996;22:508512.Google Scholar
18.Sanyal, SC, Mokaddas, EM. The increase in carbapenem use and emergence of Stenotrophomonas maltophilia as an important nosocomial pathogen. J Chemother 1999;11:2833.CrossRefGoogle ScholarPubMed
19.Etting, L, Bodey, GP. Septicemia due to Xanthomonas species and non-aeruginosa Pseudomonas species: increasing incidence of catheter-related infections. Medicine 1990;69:296306.Google Scholar
20.Villarino, ME, Stevens, LE, Schable, B, et al. Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients. Infect Control Hosp Epidemiol 1992;13:201206.Google Scholar
21.Laing, FP, Ramotar, K, Read, RR, et al. Molecular epidemiology of Xanthomonas maltophilia colonization and infection in the hospital environment. J Clin Microbiol 1995;33:513518.CrossRefGoogle ScholarPubMed
22.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.Google Scholar
23.Kerr, KG, Corps, CM, Hawkey, PM. Infections due to Xanthomonas maltophilia in patients with hematologic malignancy. Clin Infect Dis 1991;13:762.Google Scholar
24.Krcmery, V Jr, Pichna, P, Oravcova, E, et al. Stenotrophomonas maltophilia bacteremia in cancer patients: report of 31 cases. J Hosp Infect 1996;34:7577.Google Scholar
25.Weber, DJ, Rutala, WA, Blanchet, CN, Jordan, M, Gergen, MF. Faucet aerators: a source of patient colonization with Stenotrophomonas maltophilia. Am J Infect Control 1999;27:5963.CrossRefGoogle ScholarPubMed
26.Garcia de Viedma, D, Marin, M, Cercenado, E, Alonso, R, Rodriguez-Creixems, M, Bouza, E. Evidence of nosocomial Stenotrophomonas maltophilia cross-infection in a neonatology unit analyzed by three molecular typing methods. Infect Control Hosp Epidemiol 1999;20:816820.Google Scholar
27.VanCouwenbergh, C, Cohen, S. Analysis of epidemic and endemic isolates of Xanthomonas maltophilia by contour-clamped homogenous electric field gel electrophoresis. Infect Control Hosp Epidemiol 1994;15:691696.Google Scholar