Risk factors for Stenotrophomonas maltophilia bacteremia in oncology patients: a case-control study.
OBJECTIVE
To characterize risk factors for Stenotrophomonas maltophilia bloodstream infection in oncology patients.


METHODS
A 3:1 case-control study.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Apisarnthanarak
Anucha
A
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Mayfield
Jennie L
JL
Garison
Teresa
T
McLendon
Patricia M
PM
DiPersio
John F
JF
Fraser
Victoria J
VJ
Polish
Louis B
LB
D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003967:Diarrhea / Q000150:complications; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000209:etiology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009061:Mouth Mucosa / Q000473:pathology; D009369:Neoplasms / Q000150:complications* / Q000382:microbiology; D012307:Risk Factors; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification / Q000472:pathogenicity*; D013280:Stomatitis / Q000150:complications