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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 ,
Jennie L. Mayfield ,
Teresa Garison ,
Patricia M. McLendon ,
John F. DiPersio ,
Victoria J. Fraser  and
Louis B. Polish
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
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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
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 4 , April 2003 , pp. 269 - 274
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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