Stenotrophomonas maltophilia
| Stenotrophomonas maltophilia | ||||||||||||||
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| Scientific classification | ||||||||||||||
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| Binomial name | ||||||||||||||
| Stenotrophomonas maltophilia Palleroni & Bradbury 1993 | ||||||||||||||
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Pseudomonas maltophilia (ex Hugh and Ryschenkow 1961) Hugh 1981 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Stenotrophomonas maltophilia is an aerobic, nonfermentative, Gram-negative bacterium which cause uncommon but difficult to treat infections in humans.[1] Initially classified as Pseudomonas maltophilia, S. maltophilia was also grouped in the genus Xanthomonas before eventually becoming the type species of the genus Stenotrophomonas in 1993.[2][3]
Organism
S. maltophilia are slighlty smaller (0.7-1.8 x 0.4-0.7 μm) than other members of the genus. They are motile due to polar flagella and grow well on MacConkey agar producing pigmented colonies. S. maltophilia are catalase positive, oxidase negative (which distinguishes them from most other members of the genus) and have a positive reaction for extracellular DNase.
S. maltophilia is ubiquitous in aqueous environments, soil and plants, including water, urine, or respiratory secretions; it has also been used in biotechnology applications.[4] In immunocompromised patients, S. maltophilia can lead to nosocomial infections.
Pathogenesis
S. maltophila frequently colonizes breathing tubes such as endotracheal or tracheostomy tubes, the respiratory tract and indwelling urinary catheters. Infection is usually facilitated by the presence of prosthetic material (plastic or metal), and the most effective treatment is removal of the prosthetic material (usually a central venous catheter or similar device). The growth of S. maltophilia in microbiological cultures of respiratory or urinary specimens is therefore sometimes difficult to interpret and not a proof of infection. If, however, it is grown from sites which would be normally sterile (e.g., blood), then it usually represents true infection.
In immunocompetent individuals, S. maltophila is a relatively unusual cause of pneumonia, urinary tract infection, or blood stream infection; in immunocompromised patients, however, S. maltophilia is a growing source of latent pulmonary infections.[5] S. maltophilia colonization rates in individuals with cystic fibrosis have been increasing.[6]
S. maltophilia is naturally resistant to many broad-spectrum antibiotics (including all carbapenems) and is thus often difficult to eradicate. Many strains of S. maltophilia are sensitive to co-trimoxazole and ticarcillin, though resistance has been increasing.[7] It is not usually sensitive to piperacillin, and sensitivity to ceftazidime is variable.
Antimicrobial regimen
- Stenotrophomonas maltophilia[8]
- Preferred treatment: TMP-SMX 15-20 mg/kg/day (TMP component) IV/PO q8h
- Alternative treatment (1): Ceftazidime 2 g IV q8h
- Alternative treatment (2): Ticarcillin-clavulanate 3.1 g IV q4h
- Alternative treatment (3): Tigecycline 100 mg IV single dose THEN 50 mg IV q12h
- Alternative treatment (4): Ciprofloxacin 500-750 mg PO /400 mg IV q12h
- Alternative treatment (5): Moxifloxacin 400 mg PO/IV
- Alternative treatment (6): Levofloxacin 750 mg PO/IV .
- Alternative treatment (7) (Multiply-resistantance): Colistin 2.5 mg/kg q12h IV
- Note: Treatment duration uncertain, but usually ≥ 14 days.
References
- ↑ Gilligan PH, Lum G, VanDamme PAR, Whittier S (2003). Burkholderia, Stenotrophomonas, Ralstonia, Brevundimonas, Comamonas, Delftia, Pandoraea, and Acidivorax. In: Manual of Clinical Microbiology (Murray PR, Baron EJ, Jorgensen JH et al., Eds) (8th ed ed.). ASM Press, Washington, DC. pp. p729&ndash, 748. ISBN 1555812554.
- ↑ Denton M, Kerr K (1998). "Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia". Clin Microbiol Rev. 11 (1): 57–80. PMID 9457429.
- ↑ Palleroni N, Bradbury J (1993). "Stenotrophomonas, a new bacterial genus for Xanthomonas maltophilia (Hugh 1980) Swings et al. 1983". Int J Syst Bacteriol. 43 (3): 606–9. PMID 8347518.
- ↑ Berg G, Roskot N, Smalla K (1999). "Genotypic and phenotypic relationships between clinical and environmental isolates of Stenotrophomonas maltophilia". J Clin Microbiol. 37 (11): 3594–600. PMID 10523559.
- ↑ McGowan J (2006). "Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum". Am J Med. 119 (6 Suppl 1): S29–36, discussion S62-70. PMID 16735148.
- ↑ Waters V, Gómez M, Soong G, Amin S, Ernst R, Prince A (2007). "Immunostimulatory properties of the emerging pathogen Stenotrophomonas maltophilia (Epub ahead of print)". Infect Immun. PMID 17220304.
- ↑ Al-Jasser A (2006). "Stenotrophomonas maltophilia resistant to trimethoprim-sulfamethoxazole: an increasing problem". Ann Clin Microbiol Antimicrob. 5: 23. PMID 16978420.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.