Fatal hemorrhagic pneumonia in patients with hematologic diseases and Stenotrophomonas maltophilia bacteremia: a retrospective study

Abstract Background Fatal hemorrhagic pneumonia is one of the most severe manifestations of Stenotrophomonas maltophilia (SM) infections. Here, we aimed to investigate the clinical characteristics of SM bacteremia and to identify the risk factors of hemorrhagic pneumonia caused by SM in patients with hematologic diseases. Methods The clinical records of 55 patients diagnosed with hematologic diseases and SM bacteremia were retrospectively reviewed. We compared patients’ clinical characteristics and outcomes between the hemorrhagic pneumonia group and non-hemorrhagic pneumonia group. Results Twenty-seven (49.1%) patients developed hemorrhagic pneumonia. The overall mortality rate of SM bacteremia was 67.3%. The 30-day mortality rate was significantly higher in patients with hemorrhagic pneumonia than those without hemorrhagic pneumonia (85.2% and 50.0%, respectively, P = 0.003). Compared with the non-hemorrhagic pneumonia group, patients in the hemorrhagic pneumonia group were older and showed clinical manifestations as higher proportions of isolated SM in sputum culture, neutropenia and elevated procalcitonin. Multivariate analysis showed that neutropenia, high levels of procalcitonin, prior tigecycline therapy within 1 month were independent risk factors associated with hemorrhagic pneumonia. Conclusions Hematologic patients with SM bacteremia who have neutropenia, high level of procalcitonin and prior tigecycline therapy within 1 month should be early treated with combined effective antibiotics and best supportive interventions to avoid life-threatening hemorrhagic pneumonia.