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Background    Stenotrophomonas maltophilia  ( S. maltophilia ) bacteremia causes significant morbidity and mortality in immunocompromised hosts. However, incidence and risk factors for mortality in  S. maltophilia  bacteremia following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain controversial. The primary aim of this study is to clarify factors associated with poor prognosis of allo-HSCT recipients with  S. maltophilia  bacteremia.    Methods  From January 2005 to December 2014, patients with hematological diseases and  S. maltophilia  bacteremia at a single transplantation center in Japan were examined for incidence and 90-day mortality. Prognostic factors associated with 90-day mortality among allo-HSCT recipients were analyzed by log-rank test, and significant variables in the univariate analysis were included in the multivariate Cox proportional-hazards regression model.    Results  A total of 65 patients, including 47 patients undergoing allo-HSCT, developed  S. maltophilia  bacteremia. The incidence of  S. maltophilia  bacteremia was significantly higher in allo-HSCT recipients compared to patients not receiving allo-HSCT (6.53 vs. 0.36 per 100 admissions, respectively;  p  < 0.01). The overall 90-day mortality in allo-HSCT recipients was 43%. Independent risk factors for 90-day mortality were low serum albumin (<3.0 g/dl) (HR = 10.86; 95% CI, 3.27–36.12) and high serum C-reactive protein (CRP) (≥10.0 mg/dl) (HR = 3.28; 95% CI, 1.00–10.72). Among 9 patients with both high CRP and low albumin, 5 had pneumonia at the onset of bacteremia and the remaining 4 patients developed pneumonia in a median of 3 days (range, 1 to 8 days) even under effective treatment. All 9 patients eventually died in a median of 2 days (range, 2 to 32 days). The probabilities of developing pneumonia in patients with or without high CRP and low albumin levels were 100% (9/9) and 10.5% (4/38), respectively ( p  < 0.01).    Conclusions  Allo-HSCT recipients had higher rates of  S. maltophilia  bacteremia than did patients not receiving allo-HSCT. High serum CRP and low serum albumin at the onset of bacteremia are predictive of disease progression to pneumonia and poor prognosis.    Electronic supplementary material  The online version of this article (10.1186/s12879-017-2745-6) contains supplementary material, which is available to authorized users.

bmc infectious diseases

Predictive implications of albumin and C-reactive protein for progression to pneumonia and poor prognosis in Stenotrophomonas maltophilia bacteremia following allogeneic hematopoietic stem cell transplantation