Patient No. | Broad-spectrum Antibiotics | Defective Skin Barrier | CRP(mg/dL) | WBC(10³/µL) | ANC(10³/µL) | ICU Admission | Mechanical Ventilation | Concomitant BSI | CVC Removal | Antibiotic Treatment | Total Duration of Treatment (days) | Survival ***** | Follow-up (days) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | No | Yes | 3.5 | 8.2 | 0.7 | No | No | No | No | Meropenem; moxifloxacin | 14 | Yes | 2053 |
2 | Yes | Yes | 11.3 | 27.5 | 21.7 | Yes | Yes | Yes1 | Yes | TMP-SMX; meropenem;moxifloxacin; tigecyclin | 20 | Yes | 395 |
3 | Yes | No | 25.5 | 0.2 | 0 | Yes | Yes | No | No | Meropenem; fosfomycin;tigecyclin | 45 | No | 45 |
4 | No | No | 19.8 | 0 | 0 | Yes | No | No | No | Meropenem; ciprofloxacin | 1 | No | 2 |
5 | Yes | Yes | 37.9 | 0.3 | 0 | Yes | Yes | Yes2 | Yes | TMP-SMX; meropenem | 2 | No | 3 |
6 | Yes | No | 6.1 | 0.7 | 0.2 | No | No | No | Yes | Ceftazidim; colistin; moxifloxacin; tigecyclin | 18 | Yes | 167 |
7 | Yes | No | 23.0 | 0 | 0 | No | No | No | Yes | Ceftazidim; colistin; moxifloxacin; tigecyclin | 27 | Yes | 497 |
8 | Yes | Yes | 3.3 | 0 | 0 | Yes | No | No | Yes | Meropenem; colistin;moxifloxacin; tigecyclin | 10 | No | 10 |
9 | Yes | No | 9.7 | 0 | 0 | No | No | No | Yes | Meropenem; ciprofloxacin | 15 | Yes | 2446 |
10 | Yes | Yes | 15.2 | 23.3 | 18.0 | Yes | Yes | Yes3 | Yes | Ceftazidim; tobramycin | 14 | No | 79 |
ALL, acute lymphoblastic leukemia; ANC, absolute neutrophil count; BSI, blood stream infection; CRP, C-reactive protein; CVC, central venous catheter; DSP, desmoplakin; EwS, Ewing sarcoma; F, female; HCT, hematopoetic stem cell transplantation; HLH, hemophagocytic lymphohistiocytosis; ICU, intensive care unit; IST, immunosuppressive therapy; M, male; MMUD, mismatched unrelated donor; MRD, matched related donor; MUD, matched unrelated donor; SCID, severe combined immunodeficiency; SM, Stenotrophomonas maltophilia; WBC, white blood cell count; VSAA, very severe aplastic anemia.
* Associated with recurrent infections, especially skin; care at the Department of Hematology and Oncology; * Conditions in allo-HCT recipients: Patient 1, chronic graft-versus-host disease (GVHD) of the skin, off immunosuppression, low dose steroids (< 0.3 mg/kg prednisone equivalent); patient 4, primary graft failure; patient 5, chronic GVHD of the skin and the gastrointestinal tract, immunosuppression with sirolimus, anti-inflammatory antibodies, methylprednisolone 2 mg/kg/d; patients 7 and 8 were prior to engraftment. ** including pulmonary hemorrhage (please see Figure 3 for details); * patient 1 had a catheter exit-site infection, and patient 8 had necrotizing fasciitis involving the lower extremities and buttocks. ** Four patients died in direct causal relationship to the infection from pulmonary hemorrhage (patients 3,4,5) and necrotizing fasciitis (patient 7) with multiorgan failure, and one patient (patient 10) died two months after completion of treatment from unrelated causes in hospice care.
1 Staphylococcus hemolyticus, Staphylococcus aureus, Enterococcus faecalis and Candida albicans in the week prior to diagnosis of S.maltophilia infection and another blood culture positive for Staphylococcus hemolyticus in the week after; 2 Escherichia coli, Enterococcus faecium, Staphylococcus epidermidis in the week prior to diagnosis of S.maltophilia infection; 3 Pseudomonas aeruginosa, Staphylococcus hemolyticus, and Enterococcus faecium in the week prior to diagnosis of S.maltophilia infection.