The Clinical Spectrum of Stenotrophomonas (Xanthomonas) Maltophilia Respiratory Infection

Abstract

During a 15-month retrospective clinical study in an academic referral-based cancer center, 26 patients with S. maltophilia respiratory tract infections were identified (which were associated with bacteremia in 13 patients). Five of these 26 patients had previously undescribed sinopulmonary involvement. The infections were typically nosocomial. Nine patients with solid tumors had malignant involvement of the respiratory tract (five with obstruction). In two patients, the infection co-existed with pulmonary aspergillosis. Fifteen patients (58%) died of the infection. The factors that correlated with a poor outcome included bacteremic pneumonia, persistent neutropenia, presence of obstruction, development of septic shock or multiple organ dysfunction, and delay in institution of appropriate antibiotic therapy. In multivariate analysis, only septic shock and delayed therapy remained significant. Trimethoprim-sulfamethoxazole and/or ticarcillin-clavulanate were most commonly associated with a favorable outcome.

Stenotrophomonas maltophilia: Changing Spectrum of a Serious Bacterial Pathogen in Patients with Cancer

“…Necrotizing S. maltophilia pneumonia is a serious complication, and despite appropriate therapy, many patients may die because of progressive infection [38] or pulmonary hemorrhage [46]. The infection-associated deaths in patients with cancer with S. maltophilia lung infection is high (у50%) [43,44]. Patients with bacteremic pneumonia, refractory neutropenia, sepsis syndrome, and delayed appropriate antimicrobial therapy have higher probability of poor outcome.…”

“…It is also seen in patients with leukemia, most of whom are neutropenic when they develop pneumonia. The infection is often preceded by respiratory-tract colonization with S. maltophilia [43,44]. Infection is often accompanied by a paucity of acute inflammatory response.…”

“…The presence of obstructive lung cancer creates a milieu for various pathogens, including S. maltophilia, especially in those patients with chemotherapy-induced neutropenia or exposure to broad-spectrum antibiotics [43,44]. Presence of bronchial obstruction is another indicator of poor outcome.…”

Fatal hemorrhagic pneumonia caused by Stenotrophomanas maltophilia in a patient with non-Hodgkin lymphoma

“…On the other hand, S. maltophilia can cause pneumonia through hematogenous dissemination (septic emboli). The respiratory symptoms are similar to those of primary pneumonia but are associated with signs of sepsis and multiple organ dysfunction [5]. The mortality rate attributable to S. maltophilia bacteremia among patients with hematological malignancies has been reported to be 24% or 51% [6,7].…”

Stenotrophomonas MaltophiliaInfections

“…22 Like other pathogens, S. maltophilia can cause pneumonia by microaspiration (primary pneumonia) or through hematogenous dissemination (bacteremic pneumonia). 56 Primary pneumonia typically develops among debilitated patients who are exposed to prolonged antibiotic therapy and suffer from damage to the respiratory tract (chronic obstructive pulmonary disease, obstructive tumors, prolonged endotracheal intubation, and mechanical ventilation). S. maltophilia is considered an opportunistic agent of ventilator-associated pneumonia (VAP).…”