title: 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.
authors.affiliation: Department of Hematology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Mori
authors.forename: Hiroko
authors.initials: H
authors.lastname: Tsunemine
authors.forename: Kazunori
authors.initials: K
authors.lastname: Imada
authors.forename: Kiminari
authors.initials: K
authors.lastname: Ito
authors.forename: Taiichi
authors.initials: T
authors.lastname: Kodaka
authors.forename: Takayuki
authors.initials: T
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000382:microbiology; D001426:Bacterial Proteins / Q000502:physiology; D055499:Catheter-Related Infections / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D064147:Febrile Neutropenia / Q000139:chemically induced / Q000150:complications; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality; D006801:Humans; D016867:Immunocompromised Host; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D007938:Leukemia / Q000150:complications* / Q000188:drug therapy; D008171:Lung Diseases / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000382:microbiology* / Q000401:mortality; D010447:Peptide Hydrolases / Q000502:physiology; D018410:Pneumonia, Bacterial / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000401:mortality; D011859:Radiography; D012189:Retrospective Studies; D020615:Stenotrophomonas maltophilia / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D001426:Bacterial Proteins; D010447:Peptide Hydrolases