Fatal Sepsis Due to Stenotrophomonas Maltophilia in Stem Cell Recipient - Case Report

摘要

Fatal Sepsis Due to Stenotrophomonas Maltophilia in Stem Cell Recipient - Case ReportBackground: Infections are frequent cause of further morbidity and mortality in stem cells recipients. Infection-related mortality is mainly due to severe bacterial sepsis, pneumonia and fungal infections.Case Report: We report a 60 years old patient with AML. In the complete remission he is received highdose chemotherapy followed by autologous peripheral blood stem cell transplantation. The patient was treated in sterile room, conditioned with HEPA filters. Antibiotic prophylaxis regimen consisted Ciprofloxacin 1.0 gr/day, Itraconazol 400 mg/day, Acyclovir 1500 mg/day, and Immunoglobulins IV 0.1 mg/kg once per week. From day +5 patient became febrile (Ne3/mL). First line antibiotic regimen consisted third-generation anti-pseudomonal cephalosporine and amynoglicoside during a 72 h, but with no response. As a second line antibiotic therapy was introduced Vancomicyn 2.0 gr/day. On day +10 from blood culture and urine culture was isolated Stenotrophomonas maltophillia with in vitro succeptibilities only to Ciprofloxacin (+3). Co-trimoxasole and again Ciprofloxacin in maximal doses was administered, but patient deteriorate, and in sepsis with signes of endotoxic shock he die on day +15.Conclusion: Despite use of broad-spectrum antibiotics as prophylaxis, Gram-negative bacteria are still potentially fatal for immunocompromised patients. Microbiological monitoring on local microflora is mandatory for all transplant centers and intensive care units.