Life-threatening hemorrhagic pneumonia caused by Stenotrophomonas maltophilia in the treatment of hematologic diseases

Abstract

Since the late 1990s, Stenotrophomonas maltophilia (S. maltophilia) has become one of the most common nonfermenting Gram-negative bacilli that cause opportunistic infection. Patients with hematologic diseases are the most risky candidate for S. maltophilia pneumonia or sepsis because of chemotherapy-induced neutropenia or immunodeficiency. Frequent exposure to broad-spectrum antibiotics and prolonged insertion of central venous catheter further enhance the risk of S. maltophilia infection. One of the most severe S. maltophilia infections is hemorrhagic pneumonia. This type of infection is mostly fatal because of pulmonary alveolar hemorrhage that leads to acute respiratory failure. Furthermore, S. maltophilia exhibits a high-level intrinsic resistance to conventional antibiotics such as β-lactams and aminoglycosides and, more recently, the increasing acquired resistance to co-trimoxazole and quinolones. According to our experienced and previously reported cases, all of the patients with hemorrhagic pneumonia caused by S. maltophilia had a fatal course within a few days after the onset of the pneumonia. In this article, we perform a systematic review on a total 30 cases of hemorrhagic pneumonia induced by S. maltophilia from our institutions and the literature, and we describe its early diagnosis, prophylaxis, and recommended therapeutic strategy for the infection in the treatment of hematologic disease.

Haemorrhagic pneumonia caused by Stenotrophomonas maltophilia in two newborns

“…Cases of haemorrhagic pneumonia associated with SM have been reported only in patients with haematological disorders. Mori et al [3] reviewed all cases in the literature that reported patients with haemorrhagic pneumonia caused by SM. They emphasised that SM leads to fulminant and fatal haemorrhagic pneumonia.…”

Distinguishing the Causes of Pulmonary Infiltrates in Patients With Acute Leukemia

“…The clinical presentation might be severe with diffuse alveolar hemorrhage and respiratory failure. 50 Although many neutropenic patients do not produce sputum, a microbiologic analysis of sputum (Gram staining and culture) might help to establish the etiology of PI.…”

Pneumonia in the neutropenic cancer patient

“…, Serratia marcescens , Acinetobacter baumannii -complex and Proteus spp. (15, 41, 43, 44, 49–52) Unfortunately, the rise in Gram-negative neutropenic respiratory infections has also yielded a corresponding increase in extended spectrum beta-lactamase producing Enterobacteriaceae. Mortality rates associated with drug resistant P. aeruginosa and MRSA are disproportionately higher than those caused by other nosocomial bacterial pathogens.…”