Co-Occurrence of Gram-Negative Rods in Patients with Hematologic Malignancy and Sinopulmonary Mucormycosis

Author:

Egge Stephanie L.12,Wurster Sebastian3ORCID,Cho Sung-Yeon345,Jiang Ying3,Axell-House Dierdre B.12,Miller William R.12,Kontoyiannis Dimitrios P.3ORCID

Affiliation:

1. Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX 77030, USA

2. Division of Infectious Diseases, Department of Internal Medicine, Houston Methodist Hospital, Houston, TX 77030, USA

3. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA

4. Division of Infectious Diseases, Department of Internal Medicine, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea

5. Catholic Hematology Hospital, Seoul St. Mary’s Hospital, Seoul 06591, Republic of Korea

Abstract

Both Mucorales and Gram-negative rods (GNRs) commonly infect patients with hematological malignancies (HM); however, their co-occurrence is understudied. Therefore, we retrospectively reviewed the records of 63 patients with HM and proven or probable sinopulmonary mucormycosis at MD Anderson Cancer Center (Houston, Texas) from 2000–2020. Seventeen out of sixty-three reviewed patients (27.0%) had sinopulmonary co-occurrence of GNRs (most commonly Pseudomonas aeruginosa and Stenotrophomonas maltophilia) within 30 days of a positive Mucorales culture or histology demonstrating Mucorales species. Eight of seventeen co-isolations of Mucorales and GNRs were found in same-day samples. All 15 patients with GNR co-occurrence and reported antimicrobial data had received anti-Pseudomonal agents within 14 days prior to diagnosis of mucormycosis and 5/15 (33.3%) had received anti-Stenotrophomonal agents. Demographic and clinical characteristics of patients with and without GNR co-occurrence were comparable. Forty-two-day all-cause mortality was high (34.9%) and comparable in patients with (41.2%) and without (32.6%) GNR detection (p = 0.53). In summary, over a quarter of heavily immunosuppressed patients with sinopulmonary mucormycosis harbored GNRs in their respiratory tract. Although no impact on survival outcomes was seen in a background of high mortality in our relatively underpowered study, pathogenesis studies are needed to understand the mutualistic interplay of GNR and Mucorales and their influence on host responses.

Funder

Robert C. Hickey Endowment

National Institutes of Health NIH/NIAID

Gulf Coast Consortia, Texas Medical Center Training Program in Antimicrobial Resistance (TPAMR) NIH/NIAID

Publisher

MDPI AG

Reference22 articles.

1. Epidemiology and clinical manifestations of mucormycosis;Petrikkos;Clin. Infect. Dis.,2012

2. Epidemiology and clinical manifestation of fungal infection related to Mucormycosis in hematologic malignancies;Noorifard;J. Med. Life,2015

3. Alqarihi, A., Kontoyiannis, D.P., and Ibrahim, A.S. (2023). Mucormycosis in 2023: An update on pathogenesis and management. Front. Cell. Infect. Microbiol., 13.

4. Challenges in the diagnosis and treatment of mucormycosis;Skiada;Med. Mycol.,2018

5. Review of the incidence and prognosis of Pseudomonas aeruginosa infections in cancer patients in the 1990s;Maschmeyer;Eur. J. Clin. Microbiol. Infect. Dis.,2000

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