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Infections With Stenotrophomonas maltophilia in Children Undergoing Anticancer Therapy or Hematopoietic Cell

Monika Richert-Przygonska1, Krzysztof Czyzewski1, Magdalena Dziedzic1

  • 1From the Department of Pediatrics, Hematology and Oncology.

The Pediatric Infectious Disease Journal
|July 7, 2022
PubMed

Insights

Stenotrophomonas maltophilia infections are a serious risk for children with cancer or those undergoing stem cell transplants. While treatment options exist, outcomes are significantly worse for transplant patients, highlighting a critical need for improved strategies.

Area of Science:

  • Pediatric Hematology and Oncology
  • Infectious Diseases
  • Transplantation Immunology

Background:

  • Infections caused by Stenotrophomonas maltophilia (SM) are associated with high mortality rates in immunocompromised individuals.
  • Pediatric patients undergoing anticancer therapy or hematopoietic cell transplantation (HCT) are particularly vulnerable to SM infections.

Purpose of the Study:

  • To analyze the epidemiology of SM infections in children undergoing anticancer therapy (pediatric hematology and oncology [PHO]) or HCT between 2012-2019.
  • To determine the incidence, outcomes, treatment regimens, and multidrug resistance patterns of SM infections in these pediatric populations.

Main Methods:

  • A nationwide multicenter study analyzing 1356 HCTs and 7337 newly diagnosed malignancy cases in children.
  • Cumulative incidence calculated using competing risk analysis; survival determined by the Kaplan-Meier method.
  • Analysis included diagnosis of acute leukemia as a predisposing factor and antibiotic susceptibility testing.

Main Results:

  • The cumulative incidence of SM infections was similar in HCT and PHO patients (0.81% vs. 0.76%).
  • High susceptibility to trimethoprim/sulfamethoxazole (80.8%) was observed, yet survival rates were significantly lower in HCT patients (45%) compared to PHO patients (85%).
  • The transplant procedure and lack of clinical resolution after 18 days of antibiotics were independent mortality risk factors.

Conclusions:

  • The risk of SM infections and resistant strains in allogeneic HCT patients is comparable to PHO patients.
  • Despite similar infection risks and antibiotic susceptibility, outcomes for SM infections are poorer in the HCT setting compared to the PHO setting.
Abstract

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