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Dadashi M, Hajikhani B, Nazarinejad N, Noorisepehr N, Yazdani S, Hashemi A, Hashemizadeh Z, Goudarzi M, Fatemeh S. Global prevalence and distribution of antibiotic resistance among clinical isolates of Stenotrophomonas maltophilia: A systematic review and meta-analysis. J Glob Antimicrob Resist 2023; 34:253-267. [PMID: 36906172 DOI: 10.1016/j.jgar.2023.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/18/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVES Stenotrophomonas maltophilia (S. maltophilia), an opportunistic pathogen, causes infection in patients undergoing immunosuppressive therapy, mechanical ventilation, or catheters and in long-term hospitalized patients. Due to its extensive resistance to various antibiotics and chemotherapeutic agents, S. maltophilia is challenging to treat. Using case reports, case series, and prevalence studies, the current study provides a systematic review and meta-analysis of antibiotic resistance profiles across clinical isolates of S. maltophilia. METHODS A systematic literature search was performed for original research articles published in Medline, Web of Science, and Embase databases from 2000 to 2022. Statistical analysis was performed using STATA 14 software to report antibiotic resistance of S. maltophilia clinical isolates worldwide. RESULTS 223 studies (39 case reports/case series and 184 prevalence studies) were collected for analysis. A meta-analysis of prevalence studies demonstrated that the most antibiotic resistance worldwide was to levofloxacin, trimethoprim-sulfamethoxazole (TMP/SMX), and minocycline (14.4%, 9.2%, and 1.4%, respectively). Resistance to TMP/SMX (36.84%), levofloxacin (19.29%), and minocycline (1.75%) were the most prevalent antibiotic resistance types found in evaluated case reports/case series studies. The highest resistance rate to TMP/SMX was reported in Asia (19.29%), Europe (10.52%), and America (7.01%), respectively. CONCLUSION Considering the high resistance to TMP/SMX, more attention should be paid to patients' drug regimens to prevent the emergence of multidrug-resistant S. maltophilia isolates.
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Affiliation(s)
- Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nooshin Nazarinejad
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Negin Noorisepehr
- Department of Biotechnology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Shahrooz Yazdani
- Department of Cardiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Cardiovascular Research Center, Shahid Rajaei Educational and Medical Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sameni Fatemeh
- Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
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Banar M, Sattari-Maraji A, Bayatinejad G, Ebrahimi E, Jabalameli L, Beigverdi R, Emaneini M, Jabalameli F. Global prevalence and antibiotic resistance in clinical isolates of Stenotrophomonas maltophilia: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1163439. [PMID: 37215718 PMCID: PMC10196134 DOI: 10.3389/fmed.2023.1163439] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Stenotrophomonas maltophilia is a little-known environmental opportunistic bacterium that can cause broad-spectrum infections. Despite the importance of this bacterium as an emerging drug-resistant opportunistic pathogen, a comprehensive analysis of its prevalence and resistance to antibiotics has not yet been conducted. Methods A systematic search was performed using four electronic databases (MEDLINE via PubMed, Embase, Scopus, and Web of Science) up to October 2019. Out of 6,770 records, 179 were documented in the current meta-analysis according to our inclusion and exclusion criteria, and 95 studies were enrolled in the meta-analysis. Results Present analysis revealed that the global pooled prevalence of S. maltophilia was 5.3 % [95% CI, 4.1-6.7%], with a higher prevalence in the Western Pacific Region [10.5%; 95% CI, 5.7-18.6%] and a lower prevalence in the American regions [4.3%; 95% CI, 3.2-5.7%]. Based on our meta-analysis, the highest antibiotic resistance rate was against cefuroxime [99.1%; 95% CI, 97.3-99.7%], while the lowest resistance was correlated with minocycline [4·8%; 95% CI, 2.6-8.8%]. Discussion The results of this study indicated that the prevalence of S. maltophilia infections has been increasing over time. A comparison of the antibiotic resistance of S. maltophilia before and after 2010 suggested there was an increasing trend in the resistance to some antibiotics, such as tigecycline and ticarcillin-clavulanic acid. However, trimethoprim-sulfamethoxazole is still considered an effective antibiotic for treating S. maltophilia infections.
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Affiliation(s)
- Maryam Banar
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Sattari-Maraji
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazal Bayatinejad
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Ebrahimi
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Leila Jabalameli
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Reza Beigverdi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Emaneini
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Jabalameli
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Sciences, Tehran, Iran
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Milinic T, McElvaney OJ, Goss CH. Diagnosis and Management of Cystic Fibrosis Exacerbations. Semin Respir Crit Care Med 2023; 44:225-241. [PMID: 36746183 PMCID: PMC10131792 DOI: 10.1055/s-0042-1760250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
With the improving survival of cystic fibrosis (CF) patients and the advent of highly effective cystic fibrosis transmembrane conductance regulator (CFTR) therapy, the clinical spectrum of this complex multisystem disease continues to evolve. One of the most important clinical events for patients with CF in the course of this disease is acute pulmonary exacerbation (PEx). Clinical and microbial epidemiology studies of CF PEx continue to provide important insight into the disease course, prognosis, and complications. This work has now led to several large-scale clinical trials designed to clarify the treatment paradigm for CF PEx. The primary goal of this review is to provide a summary and update of the pathophysiology, clinical and microbial epidemiology, outcome and treatment of CF PEx, biomarkers for exacerbation, and the impact of highly effective modulator therapy on these events moving forward.
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Affiliation(s)
- Tijana Milinic
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Oliver J McElvaney
- Cysic Fibrosis Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, Washington
| | - Christopher H Goss
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
- Cysic Fibrosis Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Zhang S, Yang G, Jiang Y. Antibiotic and metal resistance of Stenotrophomonas maltophilia isolates from Eboling permafrost of the Tibetan Plateau. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:11798-11810. [PMID: 36097311 DOI: 10.1007/s11356-022-22888-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
Whole-genome sequencing of pathogenic bacteria Stenotrophomonas maltophilia from a less polluted environment of permafrost can help understand the intrinsic resistome of both antibiotics and metals. This study aimed to examine the maximum minimum inhibitory concentration (MIC) of both antibiotics and metals, as well as antibiotic resistance genes and metal resistance genes annotated from whole-genome sequences. The permafrost S. maltophilia was sensitive to ciprofloxacin, tetracycline, streptomycin, and bacitracin, and resistant to chloramphenicol, trimethoprim-sulfamethoxazole, erythromycin, Zn2+, Ni2+, Cu2+, and Cr6+, with a lower maximum MIC, compared with clinical S. maltophilia. The former strain belonged to the lower antibiotic resistance gene (ARG) and metal resistance gene (MRG) clusters compared with the latter ones. The permafrost strain contained no or only one kind of ARG or MRG on a single genomic island, which explained the aforementioned lower maximum MIC and less diversity of ARGs or MRGs. The result indicated that the co-occurrence of antibiotic and metal resistance was due to a certain innate ability of S. maltophilia. The continuous human use of antibiotics or metals induced selective pressure, resulting in higher MIC and more diverse ARGs and MRGs in human-impacted environments.
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Affiliation(s)
- Shuhong Zhang
- College of Biology and Food, Shangqiu Normal University, Shangqiu, China.
| | - Guangli Yang
- College of Biology and Food, Shangqiu Normal University, Shangqiu, China
| | - Yali Jiang
- College of Biology and Food, Shangqiu Normal University, Shangqiu, China
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Crémet L, Joffraud L, Eschapasse E, Bihouée T, Tissot A, Gibaud S, Persyn E. In Vitro Comparison of Aztreonam/Amoxicillin-Clavulanate Versus Aztreonam/Ceftazidime-Avibactam on Ceftazidime-Avibactam Resistant Stenotrophomonas maltophilia. Microb Drug Resist 2022; 28:877-881. [PMID: 35763306 DOI: 10.1089/mdr.2021.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We investigated the in vitro susceptibility of ceftazidime-avibactam (CZA) resistant Stenotrophomonas maltophilia to the associations aztreonam/amoxicillin-clavulanate (ATM-AMC) and ATM-CZA. Forty clinical isolates of S. maltophilia recovered from sputum samples of 40 cystic fibrosis people were selected from the collection of the Nantes University Hospital, based on their resistance to CZA. Minimum inhibitory concentrations (MICs) of ATM-CZA and ATM-AMC were determined for each isolate by an Etest strip superposition method, and by Etest for each individual antibiotic. MICs of CZA, ATM, and AMC ranged from 12 to ≥256, ≥256, and 16 to ≥256 mg/L, respectively. Synergistic effects were observed with the ATM-CZA combination for all isolates (fractional inhibitory concentration index range of 0.01 to 0.27), with combination MICs ranging from 0.75 to 16 mg/L (MIC50/90 = 3/12 mg/L), corresponding to a decrease of at least 16-folds in the MIC of ATM. In 23 (57.5%) S. maltophilia isolates, the association of AMC to ATM was also synergistic and combination MICs were ≤16 mg/L (EUCAST breakpoint for ATM resistance in Pseudomonas aeruginosa). Our results show that ATM-CZA or ATM-AMC could be alternative therapeutic options against some highly resistant S. maltophilia. This encourages further experimental studies, in particular time-kill analyses, and clinical trials to delineate conditions required for use of these combinations in practice.
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Affiliation(s)
- Lise Crémet
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France.,CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes Université, Nantes, France
| | - Léo Joffraud
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
| | | | - Tiphaine Bihouée
- CRCM pédiatrique, Hôpital Mère-enfant, CHU Nantes, Nantes, France
| | - Adrien Tissot
- Service de Pneumologie, Hôpital Nord Laennec, CHU Nantes, Nantes, France
| | - Sophie Gibaud
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
| | - Elise Persyn
- Service de Bactériologie-Hygiène, Pôle de Biologie, CHU Nantes, Nantes, France
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Gibb J, Wong DW. Antimicrobial Treatment Strategies for Stenotrophomonas maltophilia: A Focus on Novel Therapies. Antibiotics (Basel) 2021; 10:antibiotics10101226. [PMID: 34680807 PMCID: PMC8532924 DOI: 10.3390/antibiotics10101226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 12/31/2022] Open
Abstract
Stenotrophomonas maltophilia is an urgent global threat due to its increasing incidence and intrinsic antibiotic resistance. Antibiotic development has focused on carbapenem-resistant Enterobacteriaceae, Pseudomonas, and Acinetobacter, with approved antibiotics in recent years having limited activity for Stenotrophomonas. Accordingly, novel treatment strategies for Stenotrophomonas are desperately needed. We conducted a systemic literature review and offer recommendations based on current evidence for a treatment strategy of Stenotrophomonas infection.
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Activity of Aztreonam in Combination with Avibactam, Clavulanate, Relebactam, and Vaborbactam against Multidrug-Resistant Stenotrophomonas maltophilia. Antimicrob Agents Chemother 2020; 64:AAC.00297-20. [PMID: 32928733 DOI: 10.1128/aac.00297-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/04/2020] [Indexed: 12/26/2022] Open
Abstract
The intrinsic L1 metallo- and L2 serine-β-lactamases in Stenotrophomonas maltophilia make it naturally multidrug resistant and difficult to treat. There is a need to identify novel treatment strategies for this pathogen, especially against isolates resistant to first-line agents. Aztreonam in combination with avibactam has demonstrated potential, although data on other aztreonam-β-lactamase inhibitor (BLI) combinations are lacking. Additionally, molecular mechanisms for reduced susceptibility to these combinations have not been explored. The objectives of this study were to evaluate and compare the in vitro activities and to understand the mechanisms of resistance to aztreonam in combination with avibactam, clavulanate, relebactam, and vaborbactam against S. maltophilia A panel of 47 clinical S. maltophilia strains nonsusceptible to levofloxacin and/or trimethoprim-sulfamethoxazole were tested against each aztreonam-BLI combination via broth microdilution, and 6 isolates were then evaluated in time-kill analyses. Three isolates with various aztreonam-BLI MICs were subjected to whole-genome sequencing and quantitative reverse transcriptase PCR. Avibactam restored aztreonam susceptibility in 98% of aztreonam-resistant isolates, compared to 61, 71, and 15% with clavulanate, relebactam, and vaborbactam, respectively. The addition of avibactam to aztreonam resulted in a ≥2-log10-CFU/ml decrease at 24 h versus aztreonam alone against 5/6 isolates compared to 1/6 with clavulanate, 4/6 with relebactam, and 2/6 with vaborbactam. Molecular analyses revealed that decreased susceptibility to aztreonam-avibactam was associated with increased expression of genes encoding L1 and L2, as well as the efflux pump (smeABC). Aztreonam-avibactam is the most promising BLI-combination against multidrug-resistant S. maltophilia Decreased susceptibility may be due to the combination of overexpressed β-lactamases and efflux pumps. Further studies evaluating this combination against S. maltophilia are warranted.
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8
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Comparative in vitro activities of meropenem in combination with colistin, levofloxacin, or chloramphenicol against Achromobacter xylosoxidans strains isolated from patients with cystic fibrosis. J Glob Antimicrob Resist 2020; 22:713-717. [PMID: 32534046 DOI: 10.1016/j.jgar.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Achromobacter xylosoxidans is an emerging pathogen in cystic fibrosis (CF). Relatively little is known about its clinical impact and optimal management. In the present study, the in vitro bactericidal activities of meropenem, either alone or in combination with colistin, levofloxacin, or chloramphenicol, were assessed using A. xylosoxidans strains isolated from CF patients. The synergistic interactions of these combinations were also investigated. METHODS Minimal inhibitory concentrations (MICs) were determined by microbroth dilution. Bactericidal and synergistic effects of the tested antibiotic combinations were assessed by using the time-kill curve technique. RESULTS Based on the time-kill curves, we found that meropenem-colistin combinations have bactericidal and synergistic activities for 24 h against A. xylosoxidans strains, both at 1 × MIC and 4 × MIC. Although synergistic interactions were seen with meropenem-levofloxacin combinations, no bactericidal interactions were observed. Additionally, the meropenem-chloramphenicol combinations were found to be neither bactericidal nor synergistic. No antagonism was observed with any combination tested. CONCLUSIONS This study's findings could have important implications for empirical or combination antimicrobial therapy with tested antibiotics.
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Abstract
With the improving survival of cystic fibrosis (CF) patients and the advent of highly effective cystic fibrosis transmembrane conductance regulator therapy, the clinical spectrum of this complex multisystem disease continues to evolve. One of the most important clinical events for patients with CF in the course of this disease is an acute pulmonary exacerbation. Clinical and microbial epidemiology studies of CF pulmonary exacerbations continue to provide important insight into the disease course, prognosis, and complications. This work has now led to a number of large scale clinical trials with the goal of improving the treatment paradigm for CF pulmonary exacerbation. The primary goal of this review is to provide a summary of the pathophysiology, the clinical epidemiology, microbial epidemiology, outcome and the treatment of CF pulmonary exacerbation.
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Affiliation(s)
- Christopher H Goss
- CFF Therapeutics Development Network Coordinating Center, Department of Pediatrics, Seattle Children's Research Institute, Seattle, Washington.,Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine and Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Ract P, Compain F, Robin F, Decre D, Gallah S, Podglajen I. Synergistic in vitro activity between aztreonam and amoxicillin-clavulanate against Enterobacteriaceae-producing class B and/or class D carbapenemases with or without extended-spectrum β-lactamases. J Med Microbiol 2019; 68:1292-1298. [PMID: 31361213 DOI: 10.1099/jmm.0.001052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Carbapenemase-producing Enterobacteriaceae have become a major public health concern over the last decade and treatment options are limited.Aims. We evaluated the synergistic activity of the combination of aztreonam (ATM) and clavulanate for 41 β-lactam-resistant clinical isolates harbouring class B or/and class D carbapenemases combined or not with extended-spectrum β-lactamases (ESBLs).Methodology. The MICs of ATM, with and without amoxicillin-clavulanate (AMC), were determined. Time-kill assays were performed for three representative strains.Results. The ATM-AMC combination had a synergistic effect on 34/41 (83 %) isolates. The MIC of ATM, in the presence of clavulanate, was ≤1 mg l-1 for 15/41 (37 %) isolates and ≤4 mg l-1 for 29/41 (71 %) isolates. Synergistic activity was observed for 34/37 (92 %) isolates producing ESBLs and carbapenemases, compared to 0/4 (0 %) for ESBL-negative strains. Complete or partial bactericidal activity was obtained when the MIC of the combination was 0.5 mg l-1 and 1.5 mg l-1 or 8 mg l-1, respectively.Conclusion. The combination of ATM and AMC could be an attractive unconventional treatment for infections due to carbapenemase- and ESBL-producing Enterobacteriaceae.
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Affiliation(s)
- Pauline Ract
- Université Paris Descartes, Sorbonne Paris Cité, Paris 75006, France.,Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Fabrice Compain
- Université Paris Descartes, Sorbonne Paris Cité, Paris 75006, France.,Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Frédéric Robin
- Centre National de Référence de la résistance aux Antibiotiques (ESBL/cephalosporinases), CHU Clermont-Ferrand, France.,Laboratoire de Bactériologie Clinique, CHU Clermont-Ferrand, France
| | - Dominique Decre
- Université Pierre et Marie Curie, Paris, France.,Département de Bactériologie, Assistance Publique-Hôpitaux de Paris, GH Est Parisien, Paris, France
| | - Salah Gallah
- Département de Bactériologie, Assistance Publique-Hôpitaux de Paris, GH Est Parisien, Paris, France
| | - Isabelle Podglajen
- Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris 75006, France
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Ismail N, Zam Z, Hassan SA, Rahman ZA. A Combination of Trimethoprim-sulfamethoxazole and Ceftazidime Showed Good In Vitro Activity against Stenotrophomonas maltophilia. Malays J Med Sci 2017; 24:21-27. [PMID: 28894400 DOI: 10.21315/mjms2017.24.2.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 01/05/2017] [Indexed: 09/29/2022] Open
Abstract
BACKGROUND Stenotrophomonas maltophilia has emerged as an important nosocomial pathogen, capable of causing a wide spectrum of infections. Treatment is difficult because it is resistant to many antimicrobial agents, thus reducing the treatment options. The aims of this study were to describe the antimicrobial susceptibility patterns and synergistic effect of selected antimicrobial combinations against S. maltophilia isolates. METHODS This was a descriptive cross-sectional study undertaken in the Hospital Universiti Sains Malaysia from April 2011 to March 2012. S. maltophilia isolated from various clinical specimens were included in the study. Antimicrobial susceptibility testing was done using the epsilometer test (E-test) and interpreted according to the guidelines of the Clinical and Laboratory Standards Institute. In the synergy test, the isolates were tested against six different antimicrobial combinations. RESULTS In total, 84 S. maltophilia isolates were collected and analysed. According to the E-test, the antimicrobial susceptibility of trimethoprim-sulfamethoxazole (TMP-SMX), tigecycline, and ciprofloxacin was 100%, 91.1%, and 88.9% respectively. The antimicrobial combination of TMP-SMX and ceftazidime showed the highest synergistic effect. CONCLUSION TMP-SMX remains the antimicrobial of choice to treat S. maltophilia infection. TMP-SMX and ceftazidime was the most effective combination in vitro.
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Affiliation(s)
- Nabilah Ismail
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zarifah Zam
- Hospital Taiping, Jalan Taming Sari, 34000 Taiping, Perak, Malaysia
| | - Siti Asma Hassan
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zaidah Abdul Rahman
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Chang YT, Lin CY, Chen YH, Hsueh PR. Update on infections caused by Stenotrophomonas maltophilia with particular attention to resistance mechanisms and therapeutic options. Front Microbiol 2015; 6:893. [PMID: 26388847 PMCID: PMC4557615 DOI: 10.3389/fmicb.2015.00893] [Citation(s) in RCA: 231] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/17/2015] [Indexed: 01/14/2023] Open
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 β-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.
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Affiliation(s)
- Ya-Ting Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Municipal HsiaoKang Hospital Kaohsiung, Taiwan ; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University Kaohsiung, Taiwan
| | - Chun-Yu Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University Kaohsiung, Taiwan ; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, College of Medicine, Kaohsiung Medical University Kaohsiung, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University Kaohsiung, Taiwan ; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, College of Medicine, Kaohsiung Medical University Kaohsiung, Taiwan ; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University HsinChu, Taiwan
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine Taipei, Taiwan
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Cho SY, Lee DG, Choi SM, Park C, Chun HS, Park YJ, Choi JK, Lee HJ, Park SH, Choi JH, Yoo JH. Stenotrophomonas maltophilia bloodstream infection in patients with hematologic malignancies: a retrospective study and in vitro activities of antimicrobial combinations. BMC Infect Dis 2015; 15:69. [PMID: 25887489 PMCID: PMC4336707 DOI: 10.1186/s12879-015-0801-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/04/2015] [Indexed: 01/31/2023] Open
Abstract
Background Stenotrophomonas maltophilia causes serious infections in immunocompromised hosts. Here, we analyzed the clinical characteristics of S. maltophilia bloodstream infection (BSI) in patients with hematologic malignancies and evaluated in vitro synergistic effects of antimicrobial combinations. Methods We retrospectively reviewed all consecutive episodes of S. maltophilia BSIs in adult hematologic patients from June 2009 to May 2014, with in vitro susceptibility and synergy tests using high-throughput bioluminescence assay performed for available clinical isolates. Results Among 11,004 admissions during 5-year period, 31 cases were identified as S. maltophilia BSIs. The incidence rate of S. maltophilia BSI was 0.134 cases/1,000 patient-days. Overall and attributable mortality of S. maltophilia BSI was 64.5% and 38.7%, respectively. Severe neutropenia (adjusted hazard ratio [HR] 5.24, p =0.013), shock at the onset of BSI (adjusted HR 6.05, p <0.001), and pneumonia (adjusted HR 3.15, p =0.017) were independent risk factors for mortality. In vitro susceptibilities to ceftazidime, levofloxacin, ticarcillin-clavulanic acid (TIM) and trimethoprim-sulfamethoxazole (SXT) were 11.1%, 44.0%, 40.7%, and 88.9%, respectively. MIC50/MIC90 for moxifloxacin and tigecycline were 1/4 mg/L and 4/8 mg/L. The 50% and 90% fractional inhibitory concentrations (FIC50/FIC90) of clinical isolates against a combination of SXT and TIM were 0.500/0.750. For SXT plus levofloxacin or moxifloxacin, FIC50/FIC90 were 0.625/1.000 and 0.625/0.625, respectively. Conclusion S. maltophilia BSIs show high mortality, which is related to severe neutropenia, shock, and S. maltophilia pneumonia. Based upon drug susceptibility testing, the primary treatment of choice for S. maltophilia BSIs should be SXT in hematologic patients, rather than quinolones, with combination therapies including SXT serving as a feasible treatment option.
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Affiliation(s)
- Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea. .,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea. .,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea. .,The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - Su-Mi Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea. .,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - Chulmin Park
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - Hye-Sun Chun
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - Yeon-Joon Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - Jae-Ki Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea. .,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - Hyo-Jin Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea. .,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea. .,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - Jung-Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea. .,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - Jin-Hong Yoo
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea. .,Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, St. Mary's Hospital, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
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Adegoke AA, Okoh AI. Antibiogram of Stenotrophomonas maltophilia Isolated From Nkonkobe Municipality, Eastern Cape Province, South Africa. Jundishapur J Microbiol 2014; 8:e13975. [PMID: 25789125 PMCID: PMC4350050 DOI: 10.5812/jjm.13975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 11/17/2022] Open
Abstract
Background: Assessment of resistance genes is imperative, as they become disseminated to bacterial flora in plants and to the indigenous bacterial community, and thus ultimately contributes to the clinical problems of antibiotic resistant pathogens. Objectives: The research was to assess the antibiotic characteristics and incidence of sul3 genes of Stenotrophomonas maltophilia isolates recovered from rhizospheres plant in Nkonkobe Municipality. Materials and Methods: Identification and assessment of resistance genes (sul2 and sul3 genes) were carried out using polymerase chain reaction (PCR). Analytical profile index (API) was used for biochemical characterization for identification before the PCR. Antibiotic susceptibility test was carried out using the approved guidelines and standards of Clinical Laboratory Standard Institute (CLSI). Results: A total of 125 isolates were identified, composed of 120 (96%) from grass root rhizosphere and 5 (4%) from soil butternut root rhizosphere. In vitro antibiotic susceptibility tests showed varying resistances to meropenem (8.9%), cefuroxime (95.6 %), ampicillin-sulbactam (53.9%), ceftazidime (10.7%), cefepime (29.3 %), minocycline (2.2%), kanamycin (56.9%), ofloxacin (2.9%), levofloxacin (1.3%), moxifloxacin (2.8%), ciprofloxacin (24.3%), gatifloxacin (1.3%), polymyxin B (2.9 %), cotrimoxazole (26.1%), trimethoprim (98.6%) and aztreonam (58%). The isolates were susceptible to the fluoroquinolones (74.3-94.7%), polymycin (97.1%) and meropenem (88.1%). The newest sulphonamide resistance gene, sul3, was detected among the trimethoprim-sulfamethoxazole (cotrimoxazole)-resistant isolates, while the most frequent sulphonamide-resistant gene in animal source isolates, sul2, was not. Conclusions: The commensal S. maltophilia isolates in the Nkonkobe Municipality environment harbored the resistant gene sul3 as clinical counterparts, especially from the perspective of reservoirs of antibiotic resistance determinants.
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Affiliation(s)
- Anthony Ayodeji Adegoke
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Alice, South Africa
- Corresponding author: Anthony Ayodeji Adegoke, Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Alice, South Africa. Tel: +27-732387411, E-mail:
| | - Anthony I. Okoh
- Applied and Environmental Microbiology Research Group (AEMREG), Department of Biochemistry and Microbiology, University of Fort Hare, Alice, South Africa
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16
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Wang CH, Lin JC, Lin HA, Chang FY, Wang NC, Chiu SK, Lin TY, Yang YS, Kan LP, Yang CH, Chan MC, Yeh KM. Comparisons between patients with trimethoprim-sulfamethoxazole-susceptible and trimethoprim-sulfamethoxazole-resistant Stenotrophomonas maltophilia monomicrobial bacteremia: A 10-year retrospective study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:378-86. [PMID: 25081988 DOI: 10.1016/j.jmii.2014.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/13/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE The impact of bacteremia due to the resistance of Stenotrophomonas maltophilia to trimethoprim-sulfamethoxazole (TMP-SXT) is uncertain. This study compared the clinical characteristics and outcomes of patients with TMP-SXT-susceptible (TSSSM) and TMP-SXT-resistant S. maltophilia (TSRSM) monomicrobial bacteremia. METHODS The medical records of adult patients with TSSSM and TSRSM monomicrobial bacteremia from January 2004 to December 2013 were reviewed and classified into two groups, namely, TSSSM and TSRSM. RESULTS There were 184 patients with monomicrobial S. maltophilia bacteremia. The mean age was 68.3 years. Most patients were males (72.8%), had high Charlson Comorbidity Index scores, previously prescribed antimicrobial agents, and indwelling medical devices. The 14-day and in-hospital mortality rates were 23.9% and 47.2%, respectively. There were 128 patients (69.6%) with TSSSM and 56 (30.4%) with TSRSM. The incidence of TSSSM bacteremia increased during the study period. The TSSSM and TSRSM groups had similar demographic and clinical characteristics and no significant differences in 14-day and in-hospital mortality (24.2% vs. 23.2%, p = 0.833; 50.0% vs. 41.1%, p = 0.264, respectively). Patients with TSSSM bacteremia had an increased risk of septic shock (p = 0.044) and neutropenia (p = 0.028) at bacteremia onset. Logistic regression analysis indicated that acquisition of TMP-SXT resistance was an independent risk factor for prolonged hospitalization (p = 0.018) and catheter-related S. maltophilia bacteremia was inversely associated with prolonged hospitalization after bacteremia (p = 0.032). CONCLUSION There were no significant differences in mortality for patients with TSSSM and TSRSM bacteremia, but patients with TSRSM bacteremia were associated with prolonged hospitalization after bacteremia onset.
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Affiliation(s)
- Ching-Hsun Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-An Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ning-Chi Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Kang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Te-Yu Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Li-Ping Kan
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Hsuan Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ming-Chin Chan
- Infection Control Office of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Ming Yeh
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Betts JW, Phee LM, Woodford N, Wareham DW. Activity of colistin in combination with tigecycline or rifampicin against multidrug-resistant Stenotrophomonas maltophilia. Eur J Clin Microbiol Infect Dis 2014; 33:1565-72. [PMID: 24781003 DOI: 10.1007/s10096-014-2101-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/25/2014] [Indexed: 11/25/2022]
Abstract
The antimicrobial treatment of Stenotrophomonas maltophilia infections is complicated by intrinsic multidrug resistance and a lack of reliable susceptibility data. We assessed the activity of colistin (COL), rifampicin (RIF) and tigecycline (TGC) alone and in combination using a range of in vitro susceptibility testing methodologies and a simple invertebrate model of S. maltophilia infection (Galleria mellonella). Synergy [fractional inhibitory concentration indices (FICIs) ≤0.5] between COL and either RIF or TGC was observed against 92 % and 88 % of 25 S. maltophilia isolates, respectively, despite resistance to one or another of the single agents alone. In time-kill assays, COL combined with either RIF or TGC was superior to single agents, but only the COL/RIF regimen was reliably bactericidal. The in vitro findings correlated with treatment outcomes in G. mellonella, with heightened survival observed for larvae treated with COL/RIF or COL/TGC compared with COL, RIF or TGC alone. COL combined with RIF was the most effective combination overall in both in vitro and in vivo (p < 0.05) assays. Given the difficulty in selecting appropriate therapy for S. maltophilia infections, regimens consisting of COL combined with RIF or TGC could be considered for clinical use.
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Affiliation(s)
- J W Betts
- Antimicrobial Research Group, Centre for Immunology and Infectious Disease, Blizard Institute, Queen Mary, University of London, Blizard Building, 4 Newark Street, Whitechapel, London, E1 2AT, UK
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18
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The current spectrum of infection in cancer patients with chemotherapy related neutropenia. Infection 2013; 42:5-13. [PMID: 23975584 DOI: 10.1007/s15010-013-0525-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/13/2013] [Indexed: 01/03/2023]
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Tunger O, Vural S, Cetin C, Keles G, Borand H, Gazi H. Clinical Aspects and Risk Factors of NosocomialStenotrophomonas maltophiliaBacteremia Episodes in a Turkish Intensive Care Unit. J Chemother 2013; 19:658-64. [DOI: 10.1179/joc.2007.19.6.658] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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20
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Güriz H, Çiftçi E, Ayberkin E, Aysev D, Ince E, Arsan S, Yavuz G, Doğru Ü. Stenotrophomonas maltophiliabacteraemia in Turkish children. ACTA ACUST UNITED AC 2013; 28:129-36. [DOI: 10.1179/146532808x302152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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21
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Combination antimicrobial susceptibility testing of multidrug-resistant Stenotrophomonas maltophilia from cystic fibrosis patients. Antimicrob Agents Chemother 2012; 56:4071-7. [PMID: 22585220 DOI: 10.1128/aac.00072-12] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Stenotrophomonas maltophilia is increasingly being isolated from the respiratory tract of individuals with cystic fibrosis, and, because of its multidrug-resistant nature, the selection of suitable treatment regimens can be problematical. Etest methodology was used to facilitate MIC and antimicrobial combination testing on 80 isolates of S. maltophilia cultured from the respiratory tract of Scottish individuals with cystic fibrosis between 2001 and 2010. The overall rate of susceptibility for the 1,410 MIC tests was 23.1%, and resistance was 68.9%. The most active antimicrobials were minocycline, co-trimoxazole, and doxycycline, with 92.4%, 87.3%, and 58.8% of isolates being susceptible, respectively. Of the 517 combinations, 13.2% were synergistic, with the most synergistic being ticarcillin/clavulanate plus aztreonam (91.7% synergistic), ticarcillin/clavulanate plus colistin (40%), and ticarcillin/clavulanate plus levofloxacin (19.4%). Colistin plus tobramycin was the only antagonistic combination (0.2%). By the median susceptible breakpoint index, the most active combinations were minocycline plus co-trimoxazole (median index, 20), minocycline plus piperacillin-tazobactam (median, 20), and co-trimoxazole plus ceftazidime (median, 16.5). The increasing problem of multidrug resistance in organisms recovered from the respiratory tracts of individuals with cystic fibrosis is not going to go away. Current susceptibility testing methods do not address the slow-growing organisms associated with chronic infection, and interpretive standards are based on achievable blood levels of antimicrobials. Addressing these issues specifically for organisms recovered from the respiratory tracts of individuals with cystic fibrosis should lead to better therapeutic outcomes and improved wellbeing of individuals with cystic fibrosis.
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Zhang R, Sun Q, Hu YJ, Yu H, Li Y, Shen Q, Li GX, Cao JM, Yang W, Wang Q, Zhou HW, Hu YY, Chen GX. Detection of the Smqnr quinolone protection gene and its prevalence in clinical isolates of Stenotrophomonas maltophilia in China. J Med Microbiol 2011; 61:535-539. [PMID: 22096133 DOI: 10.1099/jmm.0.037309-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to detect novel variants of the Stenotrophomonas maltophilia Smqnr gene family and analyse the prevalence of Smqnr genes in clinical isolates of S. maltophilia in China. In total, 442 clinical isolates of S. maltophilia were collected from nine hospitals in four provinces in China. Antimicrobial susceptibility testing against six commonly used antibiotics was performed on these isolates. The sequences of the Smqnr genes amplified by PCR were aligned with those of known Smqnr genes in GenBank and an Smqnr database. The resistance rate against co-trimoxazole was highest at 48.6 %, followed by resistance rates against ceftazidime, chloramphenicol, ticarcillin/clavulanate and tigecycline at 28.7, 21.3, 19.0 and 16.1 %, respectively. The highest susceptibility was shown to levofloxacin, with a resistance rate of just 6.1 %. Smqnr genes were detected in 114 isolates, and comprised 11 previously identified genes and 20 new variants, bringing the total number of known Smqnr genes to 47. The 20 novel Smqnr genes were designated Smqnr28-47 and the encoded proteins showed only 1-12 amino acid differences among each other. The most common Smqnr genes in China were Smqnr8 and its variant Smqnr35 with prevalences of 17.5 % (20/114) and 13.2 % (15/114), respectively. Both the known and the novel Smqnr genes were discovered in both quinolone non-sensitive and sensitive isolates with similar frequency, suggesting that the Smqnr gene makes little contribution to quinolone resistance in this organism.
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Affiliation(s)
- Rong Zhang
- Second Affiliated Hospital of Zhejiang University, 88 JieFang Road, Hangzhou 310009, PR China
| | - Qian Sun
- Second Affiliated Hospital of Zhejiang University, 88 JieFang Road, Hangzhou 310009, PR China
| | | | - Hua Yu
- People's Hospital of Sichuan, Chengdu 610072, PR China
| | - Yi Li
- People's Hospital of Henan, Zhengzhou 450003, PR China
| | - Qiang Shen
- First People's Hospital of Hangzhou, Hangzhou 310009, PR China
| | - Guo-Xiong Li
- Central Hospital of Lishui, Lishui 323000, PR China
| | - Jun-Min Cao
- Zhejiang Hospital of Traditional Chinese Medicine, Hangzhou 310009, PR China
| | - Wei Yang
- Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310009, PR China
| | - Qin Wang
- People's Hospital of Zhuji, Zhuji 311800, PR China
| | - Hong-Wei Zhou
- Second Affiliated Hospital of Zhejiang University, 88 JieFang Road, Hangzhou 310009, PR China
| | - Yan-Yan Hu
- Second Affiliated Hospital of Zhejiang University, 88 JieFang Road, Hangzhou 310009, PR China
| | - Gong-Xiang Chen
- Second Affiliated Hospital of Zhejiang University, 88 JieFang Road, Hangzhou 310009, PR China
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Abstract
Resistance to antimicrobial drugs is increasing at an alarming rate among both gram-positive and gram-negative bacteria. Traditionally, bacteria resistant to multiple antimicrobial agents have been restricted to the nosocomial environment. A disturbing trend has been the recent emergence and spread of resistant pathogens in nursing homes, in the community, and in the hospital. This article reviews the epidemiology, molecular mechanisms of resistance, and treatment options for pathogens resistant to antimicrobial drugs.
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Affiliation(s)
- Luke F Chen
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Box 102359, Hanes House, Durham, NC 27710, USA.
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Fernández-Cuenca F, López-Cortés LE, Rodríguez-Baño J. Contribución del laboratorio de microbiología en la vigilancia y el control de brotes nosocomiales producidos por bacilos gramnegativos no fermentadores. Enferm Infecc Microbiol Clin 2011; 29 Suppl 3:40-6. [DOI: 10.1016/s0213-005x(11)70026-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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de Vrankrijker AMM, Wolfs TFW, van der Ent CK. Challenging and emerging pathogens in cystic fibrosis. Paediatr Respir Rev 2010; 11:246-54. [PMID: 21109184 DOI: 10.1016/j.prrv.2010.07.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cystic fibrosis (CF) lung disease is characterised by chronic inflammation and infection. Patients are predominantly infected by specific pathogens, of which Staphylococcus aureus and Pseudomonas aeruginosa are the most important. In recent years however there has been an increasing number of reports on potentially emerging and challenging pathogens like Stenotrophomonas maltophilia, Non-tuberculous mycobacteria, highly prevalent P. aeruginosa clones, methicillin resistant Staphylococcus aureus and Burkholderia cepacia. Also, a role for viral infections in the pathogenesis of CF lung disease has increasingly been recognised. It is not always clear whether or how these pathogens influence the progression of CF lung disease and how they should be treated. In this review, the epidemiology and clinical impact of these pathogens is discussed. Furthermore, treatment strategies of these pathogens in a CF setting are reviewed.
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Affiliation(s)
- A M M de Vrankrijker
- Department of Paediatric Respiratory Medicine, Wilhelmina Children's Hospital University Medical Centre Utrecht, Utrecht, The Netherlands
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Masgala A, Galani I, Souli M, Giamarellou H. Discrepancies between various methods in susceptibility testing and epidemiological analysis of Stenotrophomonas maltophilia clinical isolates. Cent Eur J Public Health 2010; 18:119-23. [PMID: 20939265 DOI: 10.21101/cejph.a3571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The susceptibility of 25 Stenotrophomonas maltophilia (S. maltophilia) clinical isolates to four different antimicrobials (trimethoprim/sulfomethoxazole, piperacillin/tazobactam, ceftazidime, ciprofloxacin) were investigated by disk diffusion, E-test and commercial Sensititre and PASCO broth microdilution techniques. Discrepancies between the results of broth microdilution and the other methods studied were characterized as very major, major and minor errors. Using the broth microdilution as the reference method, 24% of the isolates were found susceptible to trimethoprim/ sulfamethoxazole, 24% to ceftazidime, 0% to piperacillin/tazobactam and 12% to ciprofloxacin. Good correlation was observed between the two broth microdilution Sensititre and PASCO for all antibiotics tested. Disc diffusion and E-test generated inconsistent results for all agents except trimethoprim/sulfamethoxazole. A great genomic diversity was demonstrated within the S. maltophilia strains tested. Although our results confirm that trimethoprim-sulfamethoxazole had some in vitro activity against S. maltophilia, further clinical studies are necessary to evaluate the clinical efficacy of these compounds for the treatment of S. maltophilia infections, since no randomized controlled trials have been carried out and no correlation between the clinical response and susceptibility testing results has been reported. Furthermore, the high genomic diversity observed in the S. maltophilia strains indicates the need for careful epidemiological evaluation especially in nosocomial outbreaks.
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Affiliation(s)
- Aikaterini Masgala
- 4th Department of Internal Medicine, Molecular Biology Section, University of Athens Medical School, Athens, Greece.
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27
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Ugur A, Sarac N, Ceylan O, Emin Duru M. Antimicrobial activity and chemical composition of endemic Centaurea cariensis subsp. niveo-tomentosa. Nat Prod Res 2010; 24:861-72. [PMID: 20461631 DOI: 10.1080/14786410903315127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The antimicrobial activity of the n-hexane, chloroform, ethyl acetate and ethyl alcohol extracts of the aerial parts of Centaurea cariensis subsp. niveo-tomentosa was evaluated against microorganisms, including multi-antibiotic resistant bacteria, using the paper disc diffusion method. The chemical composition of the chloroform extract of this plant was determined by gas chromatography and gas chromatography-mass spectrometry. The chloroform extract exhibited significant antibacterial activity for all bacteria tested, which are important pathogens. The major compounds of the chloroform extract were caryophyllene oxide (20.79%), spathulenol (14.73%), beta-eudesmol (9.27%), beta-caryophyllene (6.84%), n-cetylalcohol (6.27%), cubenol (5.23%) and cis-alpha-santalol (4.67%), respectively.
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Affiliation(s)
- Aysel Ugur
- Department of Biology, Faculty of Arts and Sciences, Mugla University, 48121 Kotekli-Mugla, Turkey.
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Ugur A, Sarac N, Ceylan O, Duru ME, Beyatli Y. Chemical Composition of EndemicScorzonera sandrasicaand Studies on the Antimicrobial Activity Against Multiresistant Bacteria. J Med Food 2010; 13:635-9. [DOI: 10.1089/jmf.2008.0312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Aysel Ugur
- Department of Biology, Mugla University, Mugla, Turkey
| | - Nurdan Sarac
- Department of Medical Laboratory Program, Vocational School of Health Services, Mugla University, Mugla, Turkey
| | - Ozgur Ceylan
- Department of Nursing, Health College, Usak University, Usak, Turkey
| | - M. Emin Duru
- Department of Chemistry, Faculty of Science and Arts, Mugla University, Mugla, Turkey
| | - Yavuz Beyatli
- Department of Biology, Faculty of Science and Arts, Gazi University, Ankara, Turkey
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Comparison of different antimicrobial susceptibility testing methods for Stenotrophomonas maltophilia and results of synergy testing. J Infect Chemother 2010; 16:322-8. [PMID: 20449623 DOI: 10.1007/s10156-010-0068-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 03/25/2010] [Indexed: 10/19/2022]
Abstract
Accurate determination of resistance is important to ensure appropriate antimicrobial therapy in Stenotrophomonas maltophilia infections. This study was undertaken to evaluate the susceptibility results obtained by disc diffusion, E-test, Phoenix system, and reference agar dilution method and also to evaluate the in vitro activity of various antimicrobial combinations against multidrug-resistant S. maltophilia. Susceptibilities to several antimicrobial agents were determined by agar dilution, disc diffusion, and E-test according to the US Clinical Laboratory and Standards Institute (CLSI) guidelines. Results were also evaluated in the in Phoenix system for available agents. Twelve different antibiotic combinations were tested for synergy by the E-test method. Most synergic combinations were confirmed by microdilution checkerboard assay. Tigecycline, trimethoprim/sulfamethoxazole (TMP-SMX) and doxycycline were the most effective drugs against S. maltophilia. Poorest agreement was determined by disc diffusion and E-test against ticarcillin/clavulanate and ciprofloxacin (κ < 0.4), by disc diffusion against colistin (κ < 0.4), and by the Phoenix system against piperacillin/tazobactam (κ < 0.4). Based on these data, disc diffusion seems to be unreliable for ticarcillin/clavulanate, ciprofloxacin, and colistin; E-test for ticarcillin/clavulanate and ciprofloxacin; and the Phoenix system for piperacillin/tazobactam for S. maltophilia susceptibility testing. Synergistic activity was detected predominantly with TMP-SMX + ticarcillin/clavulanate and TMP-SMX + ceftazidime. TMP-SMX + ceftazidime synergy was also supported by the checkerboard method. However, TMP-SMX + ticarcillin/clavulanate combination revealed indifferent effect by the checkerboard assay. As ticarcillin/clavulanate and ciprofloxacin E-test results were beyond the acceptable correlation limits, synergy testing performed with these agents was considered as unreliable. Further studies are required to standardize susceptibility testing, especially for colistin, ticarcillin/clavulanate, and ciprofloxacin for S. maltophilia. TMP-SMX-containing drug combinations seemed to be more synergistic on multidrug-resistant S. maltophilia; however, these results merit further evaluation.
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Abstract
This article familiarizes the clinician with the principles of bacterial susceptibility testing and reporting to facilitate communication with the clinical microbiology laboratory. As resistance continues to emerge among a wide range of clinically relevant bacteria, the complexity of this communication increases. This updated version provides an overview of the important susceptibility concerns for most commonly isolated bacterial pathogens.
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Chen LF, Chopra T, Kaye KS. Pathogens Resistant to Antibacterial Agents. Infect Dis Clin North Am 2009; 23:817-45, vii. [DOI: 10.1016/j.idc.2009.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ugur A, Duru ME, Ceylan O, Sarac N, Varol O, Kivrak I. Chemical composition, antimicrobial and antioxidant activities ofCentaurea ensiformisHub.-Mor. (Asteraceae), a species endemic to Mugla (Turkey). Nat Prod Res 2009; 23:149-67. [DOI: 10.1080/14786410801915770] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Aysel Ugur
- a Department of Biology , Faculty of Arts and Sciences, Mugla University , Kotekli-Mugla, Turkey
| | - Mehmet Emin Duru
- b Department of Chemistry , Faculty of Arts and Sciences, Mugla University , Kotekli-Mugla, Turkey
| | - Ozgur Ceylan
- c Department of Biology , Faculty of Arts and Sciences, Mugla University , Kotekli-Mugla, Turkey
| | - Nurdan Sarac
- d Medical Laboratory Program , Vocational School of Health Services, Mugla University , Marmaris-Mugla, Turkey
| | - Omer Varol
- a Department of Biology , Faculty of Arts and Sciences, Mugla University , Kotekli-Mugla, Turkey
| | - Ibrahim Kivrak
- b Department of Chemistry , Faculty of Arts and Sciences, Mugla University , Kotekli-Mugla, Turkey
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Ugur A, Sarac N, Duru ME, Beyatli Y. In vitro Study of Antibacterial Activity on Multi-Resistant Bacteria and Chemical Composition of the Chloroform Extract of Endemic Centaurea drabifolia subsp. cappadocica. Nat Prod Commun 2009. [DOI: 10.1177/1934578x0900400922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The antimicrobial activity of the n-hexane, chloroform, ethyl acetate and ethanol extracts of the aerial parts of C. drabifolia S.M. subsp. cappadocica (DC.) Wagenitz (Asteraceae) was evaluated against microorganisms including multi-antibiotic resistant bacteria using the paper disc diffusion method. The chemical composition of the chloroform extract of this plant was determined by gas chromatography and gas chromatography-mass spectrometry. The chloroform extract exhibited significant antibacterial activity against all the bacteria tested, except Stenotrophomonas maltophilia MU63. The major compounds of the chloroform extract were spathulenol (14.1%), caryophyllene oxide (12.5%), octadecanol (10.2%), ethyl palmitate (7.7%), [Z,Z]-10,12-hexadecadienal (6.0%), 3-hydroxy p-anisaldehyde (5.9%) and pentacosane (5.8%).
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Affiliation(s)
- Aysel Ugur
- Department of Biology, Faculty of Arts and Sciences, Mugla University, Mugla TR 48121, Turkey
| | - Nurdan Sarac
- Medical Laboratory Program, Vocationary School of Health Care, Mugla University, Mugla TR 48700, Turkey
| | - M. Emin Duru
- Department of Chemistry, Faculty of Arts and Sciences, Mugla University, Mugla TR 48121, Turkey
| | - Yavuz Beyatli
- Department of Biology, Faculty of Science and Arts, Gazi University, Ankara TR 06500, Turkey
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Stenotrophomonas maltophilia responsible for respiratory infections in neonatal intensive care unit: Antibiotic susceptibility and molecular typing. ACTA ACUST UNITED AC 2009; 57:363-7. [DOI: 10.1016/j.patbio.2007.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 09/19/2007] [Indexed: 10/20/2022]
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Elborn JS. Identification and management of unusual pathogens in cystic fibrosis. J R Soc Med 2008; 101 Suppl 1:S2-5. [PMID: 18607011 DOI: 10.1258/jrsm.2008.s18002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Safdar A, Rolston KV. Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer. Clin Infect Dis 2008; 45:1602-9. [PMID: 18190323 DOI: 10.1086/522998] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Stenotrophomonas maltophilia colonization/infection in patients with cancer has significantly increased over the past 2 decades. Patients with prolonged neutropenia, exposure to broad-spectrum antibiotics, and those requiring mechanical ventilation have higher risk of infection. These micro-organisms are intrinsically resistant to carbapenems, and exposure to these agents has been linked to selection of S. maltophilia. Recently, these infections are being documented in patients without traditional risk factors. The spectrum of infection includes bacteremia, catheter-related infection, pneumonia, complicated biliary and urinary tract infection, and skin and skin-structure infection. Trimethoprim-sulfamethoxazole is the therapeutic agent of choice, but resistance is increasingly being reported. Susceptibility to alternative agents is unpredictable. Combination therapy and alternative routes of drug administration, such as aerosolized aminoglycoside, might be necessary. New insights into the mechanisms of drug resistance might lead to identification of new target sites. Agents that improve outer-membrane permeability and broad-spectrum beta-lactamase inhibitors may favorably impact difficult-to-treat (i.e., multidrug resistant) S. maltophilia infections.
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Affiliation(s)
- Amar Safdar
- Dept. of Infectious Diseases, Infection Control, and Employee Health, 402, The M. D. Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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Schaumann R, Laurin F, Rodloff AC. Molecular typing of clinical isolates of Stenotrophomonas maltophilia by pulsed-field gel electrophoresis and random primer PCR fingerprinting. Int J Hyg Environ Health 2007; 211:292-8. [PMID: 17980662 DOI: 10.1016/j.ijheh.2007.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 02/22/2007] [Accepted: 05/03/2007] [Indexed: 10/22/2022]
Abstract
During a 1-year study period, 96 strains of Stenotrophomonas maltophilia were isolated from different specimens of 59 patients admitted to a 1500 bed tertiary care university hospital. The strains were identified by commercially available API system and genotyped by pulsed-field gel electrophoresis (PFGE) and random primer PCR fingerprinting. The wide variation of the molecular profiles of the investigated S. maltophilia isolates shown by PFGE as well as PCR typing suggests that there was no outbreak situation with a particular S. maltophilia strain.
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Affiliation(s)
- Reiner Schaumann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Liebigstr. 24, D-04103 Leipzig, Germany.
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Abstract
With the improving survival of patients with cystic fibrosis (CF), the clinical spectrum of this complex multisystem disease continues to evolve. One of the most important clinical events for patients with CF in the course of this disease is an acute pulmonary exacerbation. Clinical and microbial epidemiology studies of CF pulmonary exacerbations continue to provide important insight into the course, prognosis and complications of the disease. This review provides a summary of the pathophysiology, clinical epidemiology and microbial epidemiology of a CF pulmonary exacerbation.
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Affiliation(s)
- Christopher H Goss
- Department of Medicine, University of Washington Medical Center, Campus Box 356522, 1959 NE Pacific, Seattle, Washington 98195, USA.
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Waters V, Ratjen F. Multidrug-resistant organisms in cystic fibrosis: management and infection-control issues. Expert Rev Anti Infect Ther 2007; 4:807-19. [PMID: 17140357 DOI: 10.1586/14787210.4.5.807] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic infection and inflammation are the hallmarks of cystic fibrosis lung disease. As cystic fibrosis patients are living longer owing to more intense treatment, multidrug-resistant organisms are being isolated increasingly from patients' respiratory tracts. While the adverse effects of Pseudomonas aeruginosa and Burkholderia cepacia complex are well described, less is known about the clinical significance of other emerging multidrug-resistant organisms, such as methicillin-resistant Staphylococcus aureus and Stenotrophomonas maltophilia. Owing to multiple mechanisms of antimicrobial resistance, these organisms are difficult to treat and often require combination antibiotic therapy. Until more is known about their pathogenicity and effect on clinical outcomes, physicians should be aware of the potential transmissibility of these organisms and implement adequate infection control strategies.
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Affiliation(s)
- Valerie Waters
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8 Canada
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40
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41
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Senol E. Stenotrophomonas maltophilia: the significance and role as a nosocomial pathogen. J Hosp Infect 2006; 57:1-7. [PMID: 15142709 DOI: 10.1016/j.jhin.2004.01.033] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Accepted: 01/23/2004] [Indexed: 11/20/2022]
Abstract
Stenotrophomonas maltophilia is a significant pathogen that primarily affects patients with co-morbid illnesses, usually malignancies, who have been hospitalized for prolonged periods and received broad-spectrum antibiotic therapy. The organism has been associated with an expanding spectrum of clinical manifestations associated with high case to fatality ratios. Therapy of these infections presents a significant challenge both for the clinician and the microbiologists because of its high-level antibiotic resistance to most of the currently used agents and methodological difficulties in susceptibility testing with this organism.
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Affiliation(s)
- E Senol
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Gazi University, Besevler, Ankara, Turkey.
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Tatman-Otkun M, Gürcan Ş, Özer B, Aydoslu B, Bukavaz Ş. The antimicrobial susceptibility of Stenotrophomonas maltophilia isolates using three different methods and their genetic relatedness. BMC Microbiol 2005; 5:24. [PMID: 15882456 PMCID: PMC1131904 DOI: 10.1186/1471-2180-5-24] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2004] [Accepted: 05/09/2005] [Indexed: 11/21/2022] Open
Abstract
Background Stenotrophomonas maltophilia is inherently resistant to many antimicrobials. So far, antimicrobial susceptibility tests for S. maltophilia have not been fully standardized. The purpose of the study was to compare the susceptibility of S. maltophilia isolates against seven different antimicrobials using three different methods and to investigate their genetic relatedness. Results Although trimethoprim/sulfamethoxazole (SXT) and ciprofloxacin have the lowest MIC values, SXT (98.1%) and ticarcillin/clavulanate (TLc) (73.1%) were found to be the most effective antimicrobials by agar dilution method, which was in accordance with the breakpoints established by NCCLS. Disc diffusion and E-test was in agreement with agar dilution method for SXT. When the isolation dates, clinics, antibiotyping, and AP-PCR data were investigated, two small outbreaks consisting of five and three cases were determined. Conclusion By using the NCCLS criteria, disc diffusion and E-test were unreliable alternative methods for S. maltophilia, except for SXT. However, the significance of these data should be confirmed by further experimental and clinical studies.
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Affiliation(s)
- Müşerref Tatman-Otkun
- Medical Faculty, Department of Microbiology and Clinical Microbiology, Trakya University, Turkey
| | - Şaban Gürcan
- Medical Faculty, Department of Microbiology and Clinical Microbiology, Trakya University, Turkey
| | - Burçin Özer
- Institute of Health Science, Trakya University, Turkey
| | - Bayram Aydoslu
- Medical Faculty, Department of Clinical Bacteriology and Infectious Diseases, 22030- Edirne, TURKEY Trakya University, Turkey
| | - Şebnem Bukavaz
- Medical Faculty, Department of Microbiology and Clinical Microbiology, Trakya University, Turkey
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Kaye KS, Engemann JJ, Fraimow HS, Abrutyn E. Pathogens resistant to antimicrobial agents: epidemiology, molecular mechanisms, and clinical management. Infect Dis Clin North Am 2004; 18:467-511, viii. [PMID: 15308273 DOI: 10.1016/j.idc.2004.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Resistance to antimicrobial drugs is increasing at an alarming rate among both gram-positive and gram-negative bacteria. Traditionally, bacteria resistant to multiple antimicrobial agents have been restricted to the nosocomial environment. A disturbing trend has been the recent emergence and spread of resistant pathogens and resistance traits in nursing homes, the community, as well as in hospitals. This article reviews the epidemiology, molecular mechanisms of resistance, and treatment options for pathogens resistant to antimicrobial drugs.
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Affiliation(s)
- Keith S Kaye
- Department of Medicine, Duke University Medical Center, Box 3152, Durham, NC 27710, USA.
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44
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Joyce M, Woods CW. Antibacterial susceptibility testing in the clinical laboratory. Infect Dis Clin North Am 2004; 18:401-34, vii. [PMID: 15308270 DOI: 10.1016/j.idc.2004.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article familiarizes the clinician with the principles of bacterial susceptibility testing and reporting to facilitate communication with the clinical microbiology laboratory. The emergence of resistance in nearly all commonly isolated bacterial organisms has highlighted the need for ongoing dialogue between the laboratory and those who use its services.
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Affiliation(s)
- Maria Joyce
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC 27710, USA
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Fadda G, Spanu T, Ardito F, Taddei C, Santangelo R, Siddu A, Ciccaglione D. Antimicrobial resistance among non-fermentative Gram-negative bacilli isolated from the respiratory tracts of Italian inpatients: a 3-year surveillance study by the Italian Epidemiological Survey. Int J Antimicrob Agents 2004; 23:254-61. [PMID: 15164966 DOI: 10.1016/j.ijantimicag.2003.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Italian Epidemiological Survey evaluated antibiotic susceptibility of non-fermentative Gram-negative bacilli isolated from inpatient respiratory-tract specimens collected throughout Italy during 1997-1999. The minimal inhibitory concentrations of 14 antibiotics for 1474 Pseudomonas aeruginosa strains, 307 Stenotrophomonas maltophilia strains and 114 Acinetobacter baumannii strains were determined in 57 clinical microbiology laboratories by means of a standardised micro-dilution method. The most active drugs against P. aeruginosa isolates were meropenem (81% susceptible) and amikacin (80% susceptible). Imipenem and meropenem proved to be the only agents active against A. baumannii isolates, although 13 and 16%, respectively, of strains were resistant to these drugs. Trimethoprim-sulphamethoxazole (TMP-SMZ) showed activity only against S. maltophilia isolates (83% susceptible). A total of 185 multidrug-resistant P. aeruginosa isolates (resistant to piperacillin, ceftazidime, gentamicin, and imipenem) were found. Resistance rates and trends showed consistent regional variations, including sharp increases from 1997 to 1999 in imipenem resistance among P. aeruginosa isolates from central and southern Italy.
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Affiliation(s)
- Giovanni Fadda
- Institute of Microbiology, Catholic University of the Sacred Hearth, Largo F. Vito 1, 00168 Rome, Italy.
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Kataoka D, Tanaka Y. The combination of aztreonam and cefozopran against Stenotrophomonas maltophilia. J Infect Chemother 2004; 10:62-4. [PMID: 14991523 DOI: 10.1007/s10156-003-0288-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2003] [Accepted: 10/22/2003] [Indexed: 10/26/2022]
Abstract
Aztreonam is suited for combination chemotherapy because it could be a potent Beta-lactamase inhibitor. We designed a study to show the inhibitory activity of aztreonam, using Stenotrophomonas maltophilia, which produces both carbapenemase L1 and penicillinase L2. Aztreonam showed considerable synergy with cefpirome and contributed to a decrease in minimum inhibitory concentrations of cefozopran. In further examinations, the mean viable bacterial counts in cultures treated with aztreonam-cefozopran were 1 log lower than those in cultures treated with cefozopran alone. These results confirm that inhibition of penicillinase L2 occurred. We hope that a combination chemotherapy using aztreonam and cefozopran will be used to prevent the emergence of penicillinase-producers.
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Affiliation(s)
- Daisuke Kataoka
- Department of Microbiology, Tottori University Faculty of Medicine, Yonago, Japa.
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47
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Gibson RL, Burns JL, Ramsey BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med 2003; 168:918-51. [PMID: 14555458 DOI: 10.1164/rccm.200304-505so] [Citation(s) in RCA: 1135] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This comprehensive State of the Art review summarizes the current published knowledge base regarding the pathophysiology and microbiology of pulmonary disease in cystic fibrosis (CF). The molecular basis of CF lung disease including the impact of defective cystic fibrosis transmembrane regulator (CFTR) protein function on airway physiology, mucociliary clearance, and establishment of Pseudomonas aeruginosa infection is described. An extensive review of the microbiology of CF lung disease with particular reference to infection with P. aeruginosa is provided. Other pathogens commonly associated with CF lung disease including Staphylococcal aureus, Burkholderia cepacia, Stenotrophomonas maltophilia, Achromobacter xylosoxidans and atypical mycobacteria are also described. Clinical presentation and assessment of CF lung disease including diagnostic microbiology and other measures of pulmonary health are reviewed. Current recommendations for management of CF lung disease are provided. An extensive review of antipseudomonal therapies in the settings of treatment for early P. aeruginosa infection, maintenance for patients with chronic P. aeruginosa infection, and treatment of exacerbation in pulmonary symptoms, as well as antibiotic therapies for other CF respiratory pathogens, are included. In addition, the article discusses infection control policies, therapies to optimize airway clearance and reduce inflammation, and potential future therapies.
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Affiliation(s)
- Ronald L Gibson
- Department of Pediatrics, University of Washington School of Medicine, Children's Hospital, Seattle, WA 98125, USA
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48
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Miller MB, Gilligan PH. Laboratory aspects of management of chronic pulmonary infections in patients with cystic fibrosis. J Clin Microbiol 2003; 41:4009-15. [PMID: 12958218 PMCID: PMC193835 DOI: 10.1128/jcm.41.9.4009-4015.2003] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Melissa B Miller
- Clinical Microbiology-Immunology Laboratories, University of North Carolina Hospitals, University of North Carolina School of Medicine Chapel Hill, North Carolina 27514, USA
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Kataoka D, Fujiwara H, Tanimoto A, Ikawa S, Tanaka Y. The differential beta-lactamase activity of Stenotrophomonas maltophilia. J Hosp Infect 2003; 54:247-8. [PMID: 12855245 DOI: 10.1016/s0195-6701(03)00142-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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del Toro MD, Rodríguez-Bano J, Herrero M, Rivero A, García-Ordoñez MA, Corzo J, Pérez-Cano R. Clinical epidemiology of Stenotrophomonas maltophilia colonization and infection: a multicenter study. Medicine (Baltimore) 2002; 81:228-39. [PMID: 11997719 DOI: 10.1097/00005792-200205000-00006] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Maria Dolores del Toro
- Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, Spain
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