4.7 Article

Alterations of the Oral Microbiome and Cumulative Carbapenem Exposure Are Associated With Stenotrophomonas maltophilia Infection in Patients With Acute Myeloid Leukemia Receiving Chemotherapy

期刊

CLINICAL INFECTIOUS DISEASES
卷 72, 期 9, 页码 1507-1513

出版社

OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciaa778

关键词

pneumonia; bacteremia; risk factors; colonization; meropenem

资金

  1. National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH) [R01 AI134637, R21 AI143229, K24 AI121296, U01 AI124290, K01 AI143881-01]
  2. National Institute of Diabetes and Digestive and Kidney Disease at the NIH [P30 DK56338]
  3. MD Anderson Odyssey Fellowship Program
  4. CFP Foundation
  5. UTHealth Presidential Award
  6. University of Texas STARS Award
  7. Texas Medical Center Health Policy Institute Funding Program

向作者/读者索取更多资源

This study identified the oral microbiome as a potential source for S. maltophilia infection in AML patients, while also highlighting cumulative carbapenem use as a risk factor. These findings suggest that real-time monitoring of the oral cavity could help identify patients at risk for S. maltophilia infection.
Background. Stenotrophomonas maltophilia is increasingly common in patients with acute myeloid leukemia (AML). Little is known about factors that drive S. maltophilia infection. We evaluated the microbiome and cumulative antibiotic use as predictors of S. maltophilia infection in AML patients receiving remission induction chemotherapy (RIC). Methods. Subanalysis of a prospective, observational cohort of patients with AML receiving RIC between September 2013 and August 2015 was performed. Fecal and oral microbiome samples collected from initiation of RIC until neutrophil recovery were assessed for the relative abundance of Stenotrophomonas via 16S rRNA gene quantitation. The primary outcome, microbiologically proven S. maltophilia infection, was analyzed using a time-varying Cox proportional hazards model. Results. Of 90 included patients, 8 (9%) developed S. maltophilia infection (pneumonia, n = 6; skin-soft tissue, n = 2); 4/8 (50%) patients were bacteremic; and 7/8 (88%) patients with S. maltophilia infection had detectable levels of Stenotrophomonas vs 22/82 (27%) without infection (P < .01). An oral Stenotrophomonas relative abundance of 36% predicted infection (sensitivity, 96%; specificity, 93%). No association of S. maltophilia infection with fecal relative abundance was found. Cumulative meropenem exposure was associated with increased infection risk (hazard ratio, 1.17; 95% confidence interval, 1.01-1.35; P = .03). Conclusions. Here, we identify the oral microbiome as a potential source for S. maltophilia infection and highlight cumulative carbapenem use as a risk factor for S. maltophilia in leukemia patients. These data suggest that real-time monitoring of the oral cavity might identify patients at risk for S. maltophilia infection.

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