Predictive implications of albumin and C-reactive protein for progression to pneumonia and poor prognosis in Stenotrophomonas maltophilia bacteremia following allogeneic hematopoietic stem cell transplantation

BMC Infectious Diseases

Research Article

Noritaka Sekiya¹  Shugo Sasaki¹  Kaito Harada²  Aiko Igarashi²  Masahiro Sakaguchi²  Shunichiro Yasuda²  Hisashi Sakamaki²  Satoshi Kaito²  Kazuteru Ohashi²  Shuhei Kurosawa²  Yuho Najima²  Tatsuya Konishi²  Noriko Doki²  Toshiaki Takezaki²  Hideharu Muto²  Kosuke Yoshioka²  Akihito Nagata²  Yuta Yamada²  Takeshi Hagino²  Takeshi Kobayashi²  Kyoko Watakabe-Inamoto²  Kazuhiko Kakihana² 

[1] Department of Infection Prevention and Control, and Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, 1138677, Tokyo, Japan;Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan;

关键词: Albumin;    C-reactive protein;    Stenotrophomonas maltophilia;    Hematopoietic stem cell transplantation;   

DOI  :  10.1186/s12879-017-2745-6

 received in 2017-03-29, accepted in 2017-09-18,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundStenotrophomonas maltophilia (S. maltophilia) bacteremia causes significant morbidity and mortality in immunocompromised hosts. However, incidence and risk factors for mortality in S. maltophilia bacteremia following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain controversial. The primary aim of this study is to clarify factors associated with poor prognosis of allo-HSCT recipients with S. maltophilia bacteremia.MethodsFrom January 2005 to December 2014, patients with hematological diseases and S. maltophilia bacteremia at a single transplantation center in Japan were examined for incidence and 90-day mortality. Prognostic factors associated with 90-day mortality among allo-HSCT recipients were analyzed by log-rank test, and significant variables in the univariate analysis were included in the multivariate Cox proportional-hazards regression model.ResultsA total of 65 patients, including 47 patients undergoing allo-HSCT, developed S. maltophilia bacteremia. The incidence of S. maltophilia bacteremia was significantly higher in allo-HSCT recipients compared to patients not receiving allo-HSCT (6.53 vs. 0.36 per 100 admissions, respectively; p < 0.01). The overall 90-day mortality in allo-HSCT recipients was 43%. Independent risk factors for 90-day mortality were low serum albumin (<3.0 g/dl) (HR = 10.86; 95% CI, 3.27–36.12) and high serum C-reactive protein (CRP) (≥10.0 mg/dl) (HR = 3.28; 95% CI, 1.00–10.72). Among 9 patients with both high CRP and low albumin, 5 had pneumonia at the onset of bacteremia and the remaining 4 patients developed pneumonia in a median of 3 days (range, 1 to 8 days) even under effective treatment. All 9 patients eventually died in a median of 2 days (range, 2 to 32 days). The probabilities of developing pneumonia in patients with or without high CRP and low albumin levels were 100% (9/9) and 10.5% (4/38), respectively (p < 0.01).ConclusionsAllo-HSCT recipients had higher rates of S. maltophilia bacteremia than did patients not receiving allo-HSCT. High serum CRP and low serum albumin at the onset of bacteremia are predictive of disease progression to pneumonia and poor prognosis.

【 授权许可】

CC BY   
© The Author(s). 2017