Update on infections caused by Stenotrophomonas maltophilia with particular attention to resistance mechanisms and therapeutic options
Journal
Frontiers in Microbiology
Journal Volume
6
Journal Issue
SEP
Date Issued
2015
Author(s)
Abstract
Stenotrophomonas maltophilia is a Gram-negative, biofilm-forming bacterium. Although generally regarded as an organism of low virulence, S. maltophilia is an emerging multi-drug resistant opportunistic pathogen in hospital and community settings, especially among immunocompromised hosts. Risk factors associated with S. maltophilia infection include underlying malignancy, cystic fibrosis, corticosteroid or immunosuppressant therapy, the presence of an indwelling central venous catheter and exposure to broad spectrum antibiotics. In this review, we provide a synthesis of information on current global trends in S. maltophilia pathogenicity as well as updated information on the molecular mechanisms contributing to its resistance to an array of antimicrobial agents. The prevalence of S. maltophilia infection in the general population increased from 0.8-1.4% during 1997-2003 to 1.3-1.68% during 2007-2012. The most important molecular mechanisms contributing to its resistance to antibiotics include ?-lactamase production, the expression of Qnr genes, and the presence of class 1 integrons and efflux pumps. Trimethoprim/sulfamethoxazole (TMP/SMX) is the antimicrobial drug of choice. Although a few studies have reported increased resistance to TMP/SMX, the majority of studies worldwide show that S. maltophilia continues to be highly susceptible. Drugs with historically good susceptibility results include ceftazidime, ticarcillin-clavulanate, and fluoroquinolones; however, a number of studies show an alarming trend in resistance to those agents. Tetracyclines such as tigecycline, minocycline, and doxycycline are also effective agents and consistently display good activity against S. maltophilia in various geographic regions and across different time periods. Combination therapies, novel agents, and aerosolized forms of antimicrobial drugs are currently being tested for their ability to treat infections caused by this multi-drug resistant organism. ? 2015 Chang, Lin, Chen and Hsueh.
SDGs
Other Subjects
ABC transporter; amikacin; aztreonam; beta lactam; beta lactamase; carbenicillin; ceftazidime; ciprofloxacin; clavulanic acid; colistin; cotrimoxazole; delafloxacin; doxycycline; fosfomycin; gentamicin; levofloxacin; multidrug resistance protein; polymyxin; quinoline derived antiinfective agent; rifampicin; telavancin; tetracycline derivative; ticarcillin; tigecycline; timentin; tobramycin; antibiotic sensitivity; bacterial gene; bacterial infection; clinical trial (topic); community acquired infection; disease surveillance; Gram negative bacterium; hospital infection; human; intensive care unit; mortality; multicenter study (topic); nebulization; nonhuman; phase 2 clinical trial (topic); Review; risk factor; smeABC gene; SmeDEF gene; Stenotrophomonas maltophilia; Stenotrophomonas maltophilia infection
Type
review