@article{4683aa02d6f244439599dc1ae886c684,
title = "Alterations of the Oral Microbiome and Cumulative Carbapenem Exposure Are Associated With Stenotrophomonas maltophilia Infection in Patients With Acute Myeloid Leukemia Receiving Chemotherapy",
abstract = "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. ",
keywords = "bacteremia, colonization, meropenem, pneumonia, risk factors",
author = "Aitken, {Samuel L.} and Sahasrabhojane, {Pranoti V.} and Kontoyiannis, {Dimitrios P.} and Savidge, {Tor C.} and Arias, {Cesar A.} and Ajami, {Nadim J.} and Shelburne, {Samuel A.} and Galloway-Pe{\~n}a, {Jessica R.}",
note = "Funding Information: Financial support. This work was supported by the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH; R01 AI134637, R21 AI143229, and K24 AI121296 to C. A. A.; U01 AI124290 to T. C. S.; K01 AI143881-01 to J. G. P.), the National Institute of Diabetes and Digestive and Kidney Disease at the NIH (P30 DK56338) to T. C. S., the MD Anderson Odyssey Fellowship Program (to J. G. P.), the CFP Foundation (to J. G. P.), the UTHealth Presidential Award (to C. A. A.), the University of Texas STARS Award (to C. A. A.), and the Texas Medical Center Health Policy Institute Funding Program (to C. A. A.). Funding Information: Potential conflicts of interest. S. L. A. has received research support from Melinta Therapeutics and Merck and has served on advisory boards for Shionogi, Paratek, and Merck. T. C. S. has received research support from Merck, Nivalis, Cubist, Mead Johnson, Rebiotix, BioFire, and Assembly BioSciences and has served on advisory boards for Rebiotix and BioFire. C. A. A. has received research support from Merck Inc, MeMed Diagnostics, and Entasis Therapeutics; chapter royalties from UptoDate, Harrison Principles of Internal Medicine, and Mandell Principles and Practice of Infectious Diseases; study section member and grant reviewer fees from NIH/NIAID; reimbursement for traveling to IDWeek and ID Program Committee meetings as IDWeek chair from the Infectious Diseases Society of America; reimbursement for traveling to ASM Microbe from the American Society for Microbiology; and Antimicrobial Agents and Chemotherapy editor{\textquoteright}s stipend from the American Society for Microbiology outside the submitted work. D. P. K. has received support and consultancy fees from Astellas Pharma, Cidara, Amplyx, Pulmocide and Mayne, Gilead, and United Medical; served on the advisory board of Merck; and has received the Texas 4000 Distinguished Professorship for Cancer Research and NIH-NCI Cancer Center CORE Support grant no. 16672 outside the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Publisher Copyright: {\textcopyright} 2020 The Author(s) 2020.",
year = "2021",
month = may,
day = "1",
doi = "10.1093/cid/ciaa778",
language = "English (US)",
volume = "72",
pages = "1507--1513",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "9",
}