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Hirai J, Mori N, Sakanashi D, Shibata Y, Asai N, Hagihara M, Mikamo H. Intra-Abdominal Abscess and Bacteremia Due to Stenotrophomonas maltophilia After Total Gastrectomy: A Case Report and Literature Review. Infect Drug Resist 2023; 16:7197-7204. [PMID: 38023400 PMCID: PMC10644874 DOI: 10.2147/idr.s433564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Stenotrophomonas maltophilia (S. maltophilia) is increasingly recognized as a pathogen responsible for nosocomial infections, particularly in immunocompromised patients. The most common types of S. maltophilia infections are pneumonia and catheter-related bloodstream infection, and clinical cases of intra-abdominal abscesses due to S. maltophilia are rare. We present a rare case of intra-abdominal abscess and bacteremia as a surgical site infection (SSI) caused by S. maltophilia in a patient following total gastrectomy. We also reviewed previous literature to elucidate the clinical characteristics of intra-abdominal abscess due to S. maltophilia. The patient, a 75-year-old man with diabetes and polymyositis (treated with prednisolone), developed a fever 17 days after undergoing a total gastrectomy for gastric cancer. Abdominal computed tomography revealed a hypodense solid mass at the esophagojejunostomy site, which appeared to be an intra-abdominal abscess. The culture of both blood and drained abscess pus confirmed only S. maltophilia. Treatment with intravenous trimethoprim-sulfamethoxazole and abscess drainage led to complete resolution. The patient recovered and was discharged and did not experience a recurrence. We reviewed the English literature and found only two additional case reports of intra-abdominal abscesses caused by S. maltophilia. As in our case, the intra-abdominal abscess occurred after abdominal surgery and the source was suspected to be deep SSI. This case highlights the importance of considering S. maltophilia as a potential pathogen in patients with atypical post-surgical abdominal infections. Physicians should be aware that S. maltophilia has the potential to cause intra-abdominal abscesses secondary to SSI, in addition to Enterobacteriaceae, a major causative pathogen of SSI. Further studies are required to elucidate the etiology, epidemiology, and risk factors for SSI caused by S. maltophilia.
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Affiliation(s)
- Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute, Aichi, Japan
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Nobuaki Mori
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute, Aichi, Japan
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Daisuke Sakanashi
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Yuichi Shibata
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute, Aichi, Japan
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Mao Hagihara
- Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute, Aichi, Japan
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute, Aichi, Japan
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Osakwe N. Osteomyelitis due to Stenotrophomonas maltophilia treated with trimethoprim-sulfamethoxazole monotherapy. IDCases 2023; 32:e01798. [PMID: 37229279 PMCID: PMC10205458 DOI: 10.1016/j.idcr.2023.e01798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Stenotrophomonas maltophilia is an opportunistic infection commonly encountered in various systems of the human body and has been noted to be a rare cause of osteomyelitis. This report examines a rare case of osteomyelitis of the foot caused by S. maltophilia from a poorly managed foot wound and highlights the successful treatment of this condition with trimethoprim-sulfamethoxazole monotherapy.
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Vialichka A, Biagi M, Meyer K, Wu T, Shajee A, Tan X, Wenzler E. Activity of Delafloxacin and Levofloxacin against Stenotrophomonas maltophilia at Simulated Plasma and Intrapulmonary pH Values. Microbiol Spectr 2022; 10:e0270521. [PMID: 35862943 PMCID: PMC9431699 DOI: 10.1128/spectrum.02705-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/22/2022] [Indexed: 11/20/2022] Open
Abstract
Fluoroquinolones have become a popular treatment option for Stenotrophomonas maltophilia infections. Although levofloxacin is most commonly used, delafloxacin demonstrates comparable in vitro activity when evaluated under standard susceptibility testing conditions at neutral pH. At acidic pH, the activity of the anionic delafloxacin is improved, while the activity of the zwitterionic levofloxacin is reduced. Because the human respiratory tract has a pH of ~6.6 and is the most common site of S. maltophilia infection, it is vital to understand the activity of these agents in this environment. Therefore, levofloxacin and delafloxacin were tested against clinical S. maltophilia isolates via broth microdilution testing (n = 37) and time-kill analysis (n = 5) in neutral cation-adjusted Mueller-Hinton broth (CAMHB) (pH 7.3) and acidic CAMHB (aCAMHB) (pH 6.5). In CAMHB, MIC50 values were similar between levofloxacin and delafloxacin (8 mg/L versus 8 mg/L). In aCAMHB, levofloxacin MICs did not change, while delafloxacin MICs decreased by a median of 4 log2 dilutions (MIC50 values of 8 mg/L versus 0.25 mg/L). In time-kill analyses, levofloxacin and delafloxacin at the maximum drug concentration for the free drug (fCmax) were bactericidal against 3 and 2 isolates in CAMHB, respectively. In aCAMHB, levofloxacin was not bactericidal against any isolate, while delafloxacin was bactericidal against the same 2 isolates. Relative to CAMHB, levofloxacin activity was reduced by 2.5 log10 CFU/mL in aCAMHB, whereas delafloxacin activity was increased 2.7 log10 CFU/mL. Although the bactericidal activity of levofloxacin against S. maltophilia was attenuated in an acidic environment in this study, the increased potency of delafloxacin at pH 6.5 did not translate into improved bactericidal activity in time-kill analyses, compared to pH 7.3. IMPORTANCE Stenotrophomonas maltophilia most often infects the lungs, where the physiologic environment is naturally slightly acidic (pH ~6.6), compared to most parts of the body (such as the bloodstream), which have neutral pH values (~7.4). Pneumonia due to S. maltophilia is often treated with the antibiotic levofloxacin, despite the activity of levofloxacin being known to be impaired at acidic pH. Unfortunately, currently available methods for susceptibility testing of levofloxacin against S. maltophilia are performed at a neutral pH and therefore may not accurately represent the activity of levofloxacin at the site of infection in the lungs. A similar but newer antibiotic in the same class as levofloxacin, namely, delafloxacin, is not affected by being in an acidic environment and may actually work better at lower pH values. Therefore, the purpose of this study was to investigate whether one drug might be better than the other in this setting by testing each agent's ability to kill S. maltophilia at pH 7.3 and pH 6.5. These findings could then be used to design confirmatory studies that may ultimately impact which drug is given to patients with lung infections due to S. maltophilia.
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Affiliation(s)
- Alesia Vialichka
- College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mark Biagi
- College of Pharmacy, University of Illinois Chicago, Rockford, Illinois, USA
| | - Kevin Meyer
- College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Tiffany Wu
- College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Aisha Shajee
- College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Xing Tan
- College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Eric Wenzler
- College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
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Mojica MF, Humphries R, Lipuma JJ, Mathers AJ, Rao GG, Shelburne SA, Fouts DE, Van Duin D, Bonomo RA. Clinical challenges treating Stenotrophomonas maltophilia infections: an update. JAC Antimicrob Resist 2022; 4:dlac040. [PMID: 35529051 PMCID: PMC9071536 DOI: 10.1093/jacamr/dlac040] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Stenotrophomonas maltophilia is a non-fermenting, Gram-negative bacillus that has emerged as an opportunistic nosocomial pathogen. Its intrinsic multidrug resistance makes treating infections caused by S. maltophilia a great clinical challenge. Clinical management is further complicated by its molecular heterogeneity that is reflected in the uneven distribution of antibiotic resistance and virulence determinants among different strains, the shortcomings of available antimicrobial susceptibility tests and the lack of standardized breakpoints for the handful of antibiotics with in vitro activity against this microorganism. Herein, we provide an update on the most recent literature concerning these issues, emphasizing the impact they have on clinical management of S. maltophilia infections.
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Affiliation(s)
- Maria F. Mojica
- Department of Molecular Biology and Microbiology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Case Western Reserve University-Cleveland VA Medical Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | - Romney Humphries
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John J. Lipuma
- University of Michigan Medical School, Pediatric Infectious Disease, Ann Arbor, MI, USA
| | - Amy J. Mathers
- Division of Infectious Disease and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Clinical Microbiology Laboratory, Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Gauri G. Rao
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel A. Shelburne
- Department of Infectious Diseases Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Science Center McGovern Medical School, Houston, TX, USA
| | - Derrick E. Fouts
- Genomic Medicine, The J. Craig Venter Institute, Rockville, MD, USA
| | - David Van Duin
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert A. Bonomo
- Case Western Reserve University-Cleveland VA Medical Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Senior Clinician Scientist Investigator, Veterans Affairs Northeast Ohio Healthcare System, Cleveland, OH, USA
- Medical Service and Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Northeast Ohio Healthcare System, Cleveland, OH, USA
- Departments of Medicine, Biochemistry, Pharmacology, Molecular Biology and Microbiology, and Proteomics and Bioinformatics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Kullar R, Wenzler E, Alexander J, Goldstein EJC. Overcoming Stenotrophomonas maltophilia Resistance for a More Rational Therapeutic Approach. Open Forum Infect Dis 2022; 9:ofac095. [PMID: 35415194 PMCID: PMC8992361 DOI: 10.1093/ofid/ofac095] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Stenotrophomonas maltophilia is an underappreciated source of morbidity and mortality among Gram-negative pathogens. Effective treatment options with acceptable toxicity profiles are limited. Phenotypic susceptibility testing via commercial automated test systems is problematic and no FDA breakpoints are approved for any of the first-line treatment options for S. maltophilia. The lack of modern pharmacokinetic/ pharmacodynamic data for many agents impedes dose optimization and the lack of robust efficacy and safety data limits their clinical utility. Levofloxacin has demonstrated similar efficacy to SMX-TMP, although rapid development of resistance is a concern. Minocycline demonstrates the highest rate of in vitro susceptibility, however, evidence to support its clinical use are scant. Novel agents such as cefiderocol have exhibited promising activity in pre-clinical investigations, though additional outcomes data are needed to determine its place in therapy for S. maltophilia. Combination therapy is often employed despite the dearth of adequate supporting data.
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Affiliation(s)
| | - Eric Wenzler
- College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Jose Alexander
- Department of Microbiology, Virology, and Immunology, AdventHealth Central Florida, Orlando, FL, USA
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Petca RC, Dănău RA, Popescu RI, Damian D, Mareș C, Petca A, Jinga V. Xanthogranulomatous Pyelonephritis Caused by Stenotrophomonas maltophilia—The First Case Report and Brief Review. Pathogens 2022; 11:pathogens11010081. [PMID: 35056029 PMCID: PMC8779545 DOI: 10.3390/pathogens11010081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 12/23/2022] Open
Abstract
Xanthogranulomatous pyelonephritis (XGP) represents a rare and severe pathology secondary to chronic urinary obstruction and recurrent infections. Commonly, this condition leads to loss of kidney function, and frequently, surgical approach is the only optional treatment. Proteus mirabilis and Escherichia coli are the most frequent pathogens associated with XGP. The actual changes in the pathogen’s characteristics increased the risk of newly acquired infections once considered opportunistic. Stenotrophomonas malthophilia is one of those agents more related to immunocompromised patients, presenting an increased incidence and modified antibiotic resistance profile in the modern era. This case report presents a healthy female patient with an underlying renal stone pathology diagnosed with XGP related to S. maltophilia urinary infection. After a complete biological and imagistic evaluation, the case was treated as pyonephrosis. Empirical antibiotic administration and a surgical approach were considered. A total nephrectomy was performed, but the patient’s condition did not improve. The patient’s status improved when specific antibiotics were administered based on the bacterial identification and antibiotic susceptibility pattern of drained perinephric fluid. Levofloxacin and Vancomycin were considered the optimal combination in this case. The histopathological examination revealed XGP secondary to chronic renal stone. The present study describes the first case of XGP related to an aerobic Gram-negative pathogen such as S. maltophilia, once considered opportunistic, in an apparently healthy female adult.
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Affiliation(s)
- Răzvan-Cosmin Petca
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.-C.P.); (R.-A.D.); (C.M.); (A.P.); (V.J.)
- Department of Urology, “Prof. Dr. Theodor Burghele” Clinical Hospital, 050659 Bucharest, Romania;
| | - Răzvan-Alexandru Dănău
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.-C.P.); (R.-A.D.); (C.M.); (A.P.); (V.J.)
- Department of Urology, “Prof. Dr. Theodor Burghele” Clinical Hospital, 050659 Bucharest, Romania;
| | - Răzvan-Ionuț Popescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.-C.P.); (R.-A.D.); (C.M.); (A.P.); (V.J.)
- Department of Urology, “Prof. Dr. Theodor Burghele” Clinical Hospital, 050659 Bucharest, Romania;
- Correspondence: ; Tel.: +40-720-492823
| | - Daniel Damian
- Department of Urology, “Prof. Dr. Theodor Burghele” Clinical Hospital, 050659 Bucharest, Romania;
| | - Cristian Mareș
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.-C.P.); (R.-A.D.); (C.M.); (A.P.); (V.J.)
- Department of Urology, “Prof. Dr. Theodor Burghele” Clinical Hospital, 050659 Bucharest, Romania;
| | - Aida Petca
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.-C.P.); (R.-A.D.); (C.M.); (A.P.); (V.J.)
- Department of Obstetrics and Gynecology, Elias University Hospital, 011461 Bucharest, Romania
| | - Viorel Jinga
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.-C.P.); (R.-A.D.); (C.M.); (A.P.); (V.J.)
- Department of Urology, “Prof. Dr. Theodor Burghele” Clinical Hospital, 050659 Bucharest, Romania;
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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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Clinical outcomes of Stenotrophomonas maltophilia infection treated with trimethoprim/sulfamethoxazole, minocycline, or fluoroquinolone monotherapy. Int J Antimicrob Agents 2021; 58:106367. [PMID: 34058337 DOI: 10.1016/j.ijantimicag.2021.106367] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The historical treatment of choice for Stenotrophomonas maltophilia infection is trimethoprim/sulfamethoxazole and this is primarily based on preclinical studies. The objective of this study was to examine the clinical outcomes of patients receiving monotherapy with different agents. METHODS This was a retrospective study of adult patients receiving monotherapy for S. maltophilia infection with trimethoprim/sulfamethoxazole (TMP/SMX), a fluoroquinolone, or minocycline from 2010 to 2016. The primary outcome was clinical failure, a composite of recurrence, alteration of therapy due to adverse reaction or concern for clinical failure, or 30-day in-hospital mortality. The secondary outcome was 30-day in-hospital mortality. To account for treatment selection bias, multivariate regression and propensity score weighting were conducted. RESULTS 284 patients were included (217 received TMP/SMX, 28 received a fluoroquinolone, and 39 received minocycline). The TMP/SMX and minocycline groups appeared to include similar patients whereas the fluoroquinolone group appeared to represent a slightly less severely ill population. Clinical failure was similar between groups (36%, 29%, and 31% in the TMP/SMX, fluoroquinolone, and minocycline groups, respectively, P=0.69) as was 30-day mortality (15%, 7%, and 5% in the TMP/SMX, fluoroquinolone, and minocycline groups, respectively, P=0.16). After controlling for confounding factors, receipt of minocycline (adjusted odds ratio [OR]=0.2 [0.1-0.7]) but not a fluoroquinolone (adjusted OR=0.3 [0.1 to 2.1]) was associated with lower mortality compared with TMP/SMX. This association persisted after propensity score weighting. CONCLUSIONS Outcomes were similar or better with alternatives to TMP/SMX monotherapy, which indicates this may not be the treatment of choice for infections caused by S. maltophilia.
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Venditti M, Martino P. The Importance of In-Vitro Susceptibility Testing in the Management of Compromised Hosts. J Chemother 2021. [DOI: 10.1080/1120009x.1997.12113197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - P. Martino
- Dipartimento di Biopatologia Umana, Università “La Sapienza”, Rome, Italy
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Kim JH, Kim JW, Jo J, Straub JH, Cross M, Hofmann A, Kim JS. Characterisation of trehalose-6-phosphate phosphatases from bacterial pathogens. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2020; 1869:140564. [PMID: 33171283 DOI: 10.1016/j.bbapap.2020.140564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/12/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
The trehalose biosynthesis pathway has recently received attention for therapeutic intervention combating infectious diseases caused by bacteria, helminths or fungi. Trehalose-6-phosphate phosphatase (TPP) is a key enzyme of the most common trehalose biosynthesis pathway and a particularly attractive target owing to the toxicity of accumulated trehalose-6-phosphate in pathogens. Here, we characterised TPP-like proteins from bacterial pathogens implicated in nosocomial infections in terms of their steady-state kinetics as well as pH- and metal-dependency of their enzymatic activity. Analysis of the steady-state kinetics of recombinantly expressed enzymes from Acinetobacter baumannii, Corynebacterium diphtheriae and Pseudomonas stutzeri yielded similar kinetic parameters as those of other reported bacterial TPPs. In contrast to nematode TPPs, the divalent metal ion appears to be bound only weakly in the active site of bacterial TPPs, allowing the exchange of the resident magnesium ion with other metal ions. Enzymatic activity comparable to the wild-type enzyme was observed for the TPP from P. stutzeri with manganese, cobalt and nickel. Analysis of the enzymatic activity of S. maltophilia TPP active site mutants provides evidence for the involvement of four canonical aspartate residues as well as a strictly conserved histidine residue of TPP-like proteins from bacteria in the enzyme mechanism. That histidine residue is a member of an interconnected network of five conserved residues in the active site of bacterial TPPs which likely constitute one or more functional units, directly or indirectly cooperating to enhance different aspects of the catalytic activity.
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Affiliation(s)
- Jun-Hong Kim
- Department of Chemistry, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Ji-Won Kim
- Department of Chemistry, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Jiwon Jo
- Department of Chemistry, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Jan Hendrik Straub
- Griffith Institute for Drug Discovery, Griffith University, Nathan, Queensland 4111, Australia
| | - Megan Cross
- Griffith Institute for Drug Discovery, Griffith University, Nathan, Queensland 4111, Australia
| | - Andreas Hofmann
- Griffith Institute for Drug Discovery, Griffith University, Nathan, Queensland 4111, Australia; Department of Veterinary Biosciences, Melbourne Veterinary School, The University of Melbourne, Parkville, Victoria 3010, Australia.
| | - Jeong-Sun Kim
- Department of Chemistry, Chonnam National University, Gwangju 61186, Republic of Korea.
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11
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Ferreira MA, Pereira ML, Dos Santos KV. Drug-induced tolerance: the effects of antibiotic pre-exposure in Stenotrophomonas maltophilia. Future Microbiol 2020; 15:497-508. [PMID: 32478618 DOI: 10.2217/fmb-2019-0253] [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] [Indexed: 02/02/2023] Open
Abstract
Aim: To investigate if the prior use of nontargeted antibiotics induces cross-tolerance in Stenotrophomonas maltophilia. Methods: Antibiotic induction was performed to evaluate daptomycin and vancomycin as possible tolerance-inducing drugs measured by minimum bactericidal concentration/minimum inhibitory concentration (MIC) ratio, adapted disk-diffusion tests and time-kill curves. Results: After antibiotic exposure, three potentially tolerant strains were isolated, maintaining the same MIC value of levofloxacin, with minimum bactericidal concentration/MIC ratio slightly higher than the parental. In the adapted disk-diffusion test, one strain (D25) showed high tolerance level for levofloxacin, ceftazidime and ticarcillin-clavulanate. In time-kill activity of levofloxacin, D25 presented a subpopulation of persisters with survival rate higher (1.6-fold) than the parental. Conclusion: Previous exposure of S. maltophilia to daptomycin can induce cross-tolerance to ceftazidime and ticarcillin-clavulanate and cross-persistence to levofloxacin.
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Affiliation(s)
- Mariana Am Ferreira
- Department of Pathology, Health Sciences Center, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, 29040-090 Vitória, Espírito Santo, Brazil
| | - Maria Ls Pereira
- Department of Pathology, Health Sciences Center, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, 29040-090 Vitória, Espírito Santo, Brazil
| | - Kênia V Dos Santos
- Department of Pathology, Health Sciences Center, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, 29040-090 Vitória, Espírito Santo, Brazil
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12
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Wang CH, Yu CM, Hsu ST, Wu RX. Levofloxacin-resistant Stenotrophomonas maltophilia: risk factors and antibiotic susceptibility patterns in hospitalized patients. J Hosp Infect 2019; 104:46-52. [PMID: 31505224 DOI: 10.1016/j.jhin.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Levofloxacin has been considered as an alternative treatment for Stenotrophomonas maltophilia infection. However, levofloxacin-resistant S. maltophilia (LRSM) are emerging worldwide. AIM To investigate LRSM risk factors in hospitalized patients and to determine antibiotic susceptibility patterns of LRSM isolates. METHODS In a retrospective matched case-control-control study, LRSM patients (the case group) were compared with two control groups: levofloxacin-susceptible S. maltophilia (LSSM) patients (control group A) and non-S. maltophilia-infected patients (control group B). Conditional logistic regression was used to analyse risk factors for LRSM occurrence. Tigecycline, ceftazidime, colistin, and trimethoprim/sulfamethoxazole (TMP/SMX) susceptibilities in collected LRSM clinical isolates were determined. FINDINGS A total of 105 LRSM, 105 LSSM, and 105 non-S. maltophilia-infected patients were analysed. The first multivariate analysis (cases vs group A) revealed that previous fluoroquinolones use was significantly associated with LRSM occurrence, and the second multivariate analysis (cases vs group B) revealed that previous fluoroquinolone use, previous intensive care unit stay, and the number of previous exposures to different classes of antibiotics were significantly associated with LRSM occurrence. Of all the LRSM isolates tested for antibiotic susceptibility, ceftazidime, TMP/SMX, tigecycline, and colistin resistance rates were 42.0, 99.0, 78.0, and 40.0%, respectively. CONCLUSION LRSM antibiotic susceptibility patterns revealed multiple-drug resistance, which further limits treatment options for clinicians. To reduce LRSM occurrence, proper use of antibiotics, especially fluoroquinolones, is mandatory.
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Affiliation(s)
- C H Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - C-M Yu
- Department of Clinical Pathology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - S-T Hsu
- Infection Control Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - R-X Wu
- Division of Infectious Diseases, Tri-Service General Hospital Penghu Branch, Penghu, Taiwan.
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Sumi CD, Heffernan AJ, Lipman J, Roberts JA, Sime FB. What Antibiotic Exposures Are Required to Suppress the Emergence of Resistance for Gram-Negative Bacteria? A Systematic Review. Clin Pharmacokinet 2019; 58:1407-1443. [DOI: 10.1007/s40262-019-00791-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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14
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K Thet M, Pelobello MLF, Das M, Alhaji MM, Chong VH, Khalil MAM, Chinniah T, Tan J. Outbreak of nonfermentative Gram-negative bacteria (Ralstonia pickettii and Stenotrophomonas maltophilia) in a hemodialysis center. Hemodial Int 2019; 23:E83-E89. [PMID: 30746829 DOI: 10.1111/hdi.12722] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We report a case series of seven patients with nonfermentative Gram-negative bacteria infections in a single dialysis center; four patients with Ralstonia pickettii and three patients with Stenotrophomonas maltophilia. Two of the seven patients were admitted to hospital for intravenous antibiotic treatment, while the rest were treated with oral antibiotics at home. Both the admitted patients had temporary vascular catheter infections from the aforementioned pathogens. We conclude that the outbreak is due to colonization of treated reverse osmosis water, presumably through contamination via polluted filters and compounded by the usage of reprocessed dialysers in the dialysis center. This is especially relevant because contaminated treated water is directly introduced into the blood compartment of the dialysers during reprocessing. In addition, there seems to be a propensity for both organisms to cause prolonged febrile reactions in patients with temporary vascular catheters, likely through the early development of biofilm. Intensification of general sterilization procedures, servicing and replacement of old decrepit components of the water treatment system and temporary cessation of dialyser reuse practice seem to have halted the outbreak. Due to the virulent nature and difficult resistant profile of nonfermentative Gram-negative bacteria, we strongly recommend meticulous vigilance in the surveillance of culture isolates in routine microbiological specimens from dialysis centers, especially if there is a senescent water treatment system and a practice of reprocessing dialysers.
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Affiliation(s)
- May K Thet
- Department of Renal Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | - Milton Das
- Department of Renal Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Mohammed M Alhaji
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
| | - Vui Heng Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | - Terence Chinniah
- Department of Microbiology, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | - Jackson Tan
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei Darussalam
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Baidya A, Kodan P, Fazal F, Tsering S, Menon PR, Jorwal P, Chowdhury UK. Stenotrophomonas maltophilia: More than Just a Colonizer! Indian J Crit Care Med 2019; 23:434-436. [PMID: 31645832 PMCID: PMC6775712 DOI: 10.5005/jp-journals-10071-23241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Stenotrophomonas maltophilia is an emerging gram-negative pathogen that was previously labeled as a colonizer. Nowadays, with multiple antibiotic usage along with certain host factors, infections caused by this organism are getting attention. We hereby report two cases of ventilator-associated pneumonia in postoperative infants by Stenotrophomonas maltophilia in a cardiac intensive care unit (ICU). How to cite this article: Baidya A, Kodan P, Fazal F, Tsering S, Menon RP, Jorwal P, et al. Stenotrophomonas maltophilia: More than Just a Colonizer! Indian J Crit Care Med 2019;23(9):434–436.
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Affiliation(s)
- Ankita Baidya
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parul Kodan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Farhan Fazal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandgup Tsering
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - P Ramesh Menon
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Jorwal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ujjwal Kumar Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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16
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Ko JH, Kang CI, Cornejo-Juárez P, Yeh KM, Wang CH, Cho SY, Gözel MG, Kim SH, Hsueh PR, Sekiya N, Matsumura Y, Lee DG, Cho SY, Shiratori S, Kim YJ, Chung DR, Peck KR. Fluoroquinolones versus trimethoprim-sulfamethoxazole for the treatment of Stenotrophomonas maltophilia infections: a systematic review and meta-analysis. Clin Microbiol Infect 2018; 25:546-554. [PMID: 30448331 DOI: 10.1016/j.cmi.2018.11.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/05/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Fluoroquinolones are a popular alternative to trimethoprim-sulfamethoxazole for Stenotrophomonas maltophilia infections. OBJECTIVES To compare the effects of fluoroquinolones and trimethoprim-sulfamethoxazole on mortality of S. maltophilia infections. DATA SOURCES PubMed and EMBASE. STUDY ELIGIBILITY CRITERIA Clinical studies reporting mortality outcomes of S. maltophilia infections. PARTICIPANTS Patients with clinical infections caused by S. maltophilia. INTERVENTIONS Fluoroquinolone monotherapy in comparison with trimethoprim-sulfamethoxazole monotherapy. METHODS Systematic review with meta-analysis technique. RESULTS Seven retrospective cohort and seven case-control studies were included. Three cohort studies were designed to compare the two drugs, whereas others had other purposes. A total of 663 patients were identified, 332 of which were treated with trimethoprim-sulfamethoxazole (50.1%) and 331 with fluoroquinolones (49.9%). Three cohort studies were designed to compare the effect of the two drugs, whereas the others had other purposes. Levofloxacin was most frequently used among fluoroquinolones (187/331, 56.5%), followed by ciprofloxacin (114/331, 34.4%). The overall mortality rate was 29.6%. Using pooled ORs for the mortality of each study, fluoroquinolone treatment (OR 0.62, 95% CI 0.39-0.99) was associated with survival benefit over trimethoprim-sulfamethoxazole treatment, with low heterogeneity (I2 = 18%). Specific fluoroquinolones such as ciprofloxacin (OR 0.44, 95% CI 0.17-1.12) and levofloxacin (OR 0.78, 95% CI 0.48-1.26) did not show a significant difference in comparison with trimethoprim-sulfamethoxazole. In the sub-group analyses of adult and bacteraemic patients, significant differences in mortality were not observed between fluoroquinolones and trimethoprim-sulfamethoxazole. CONCLUSIONS Based on a meta-analysis of non-randomized studies, fluoroquinolones demonstrated comparable effects on mortality of S. maltophilia infection to trimethoprim-sulfamethoxazole, supporting the use of fluoroquinolones in clinical S. maltophilia infections. Although the pooled analysis of overall studies favoured fluoroquinolones over trimethoprim-sulfamethoxazole, the studies included were observational, and sub-group analyses of certain fluoroquinolone agents did not show statistical differences with trimethoprim-sulfamethoxazole. Randomized clinical studies are needed to address these issues.
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Affiliation(s)
- J-H Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - C-I Kang
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - P Cornejo-Juárez
- Departamento de Infectología, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - K-M Yeh
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan
| | - C-H Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan
| | - S Y Cho
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - M G Gözel
- Department of Microbiology Reference Laboratories, Ministry of Health, Public Health, Turkey
| | - S-H Kim
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - P-R Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - N Sekiya
- Department of Infection Prevention and Control, Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Centre Komagome Hospital, Tokyo, Japan
| | - Y Matsumura
- Kyoto University Graduate School of Medicine, Department of Clinical Laboratory Medicine, Kyoto, Japan
| | - D-G Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St Mary's Hospital, Seoul, Republic of Korea
| | - S-Y Cho
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, St Mary's Hospital, Seoul, Republic of Korea
| | - S Shiratori
- Department of Haematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Y-J Kim
- Division of Infectious Diseases, Department of Paediatrics, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - D R Chung
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - K R Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ebara H, Hagiya H, Haruki Y, Kondo E, Otsuka F. Clinical Characteristics of Stenotrophomonas maltophilia Bacteremia: A Regional Report and a Review of a Japanese Case Series. Intern Med 2017; 56:137-142. [PMID: 28090041 PMCID: PMC5337456 DOI: 10.2169/internalmedicine.56.6141] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective Stenotrophomonas maltophilia is an emerging nosocomial pathogen that causes fatal infections in critically ill or immunocompromised patients. S. maltophilia bacteremia (SMB) is a rare condition, and its clinical characteristics in Japanese settings are not well known. Methods The medical charts of patients with SMB were retrospectively reviewed at two medical facilities (Okayama University Hospital and Tsuyama Chuo Hospital) for seven years. The data were analyzed along with those previously reported from other Japanese facilities. Result A total of 181 patients (110 men and 71 women) were evaluated. The major underlying diseases included hematologic malignancy (36.5%), solid organ malignancy (25.4%), and neutropenia (31.5%). The recent use of carbapenem was seen in 56.9% of the cases in total, and more than one-third of the patients in our hospitals were treated with carbapenem at the onset of SMB. Of 28 (63.6%) of 44 cases treated for S. maltophilia, those who did not survive were more likely to have been treated with broad-spectrum antibiotics. A multivariate analysis revealed that a higher updated Charlson Comorbidity Index [odds ratio (95% confidence interval), 1.75 (1.11-2.75); p=0.015] and intubation [odds ratio (95% confidence interval), 12.6 (1.62-97.9); p=0.016] were associated with mortality in our cases. Pathogens were often resistant to ceftazidime but susceptible to minocycline, trimethoprim/sulfamethoxazole, and fluoroquinolones. The overall mortality rates within 30 and 90 days were 37.5% and 62.5%, respectively. Conclusion The clinical characteristics of SMB in Japanese cases were similar to those reported from other countries. Clinicians should be aware that breakthrough infection by S. maltophilia may occur during administration of carbapenem.
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Affiliation(s)
- Hirotaka Ebara
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Whole-genome sequencing identifies emergence of a quinolone resistance mutation in a case of Stenotrophomonas maltophilia bacteremia. Antimicrob Agents Chemother 2015; 59:7117-20. [PMID: 26324280 DOI: 10.1128/aac.01723-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/20/2015] [Indexed: 01/11/2023] Open
Abstract
Whole-genome sequences for Stenotrophomonas maltophilia serial isolates from a bacteremic patient before and after development of levofloxacin resistance were assembled de novo and differed by one single-nucleotide variant in smeT, a repressor for multidrug efflux operon smeDEF. Along with sequenced isolates from five contemporaneous cases, they displayed considerable diversity compared against all published complete genomes. Whole-genome sequencing and complete assembly can conclusively identify resistance mechanisms emerging in S. maltophilia strains during clinical therapy.
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19
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Jia W, Wang J, Xu H, Li G. Resistance of Stenotrophomonas maltophilia to Fluoroquinolones: Prevalence in a University Hospital and Possible Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5177-95. [PMID: 25985315 PMCID: PMC4454961 DOI: 10.3390/ijerph120505177] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/04/2015] [Indexed: 12/23/2022]
Abstract
Objective: The purpose of this study was to investigate the clinical distribution and genotyping of Stenotrophomonas maltophilia, its resistance to antimicrobial agents, and the possible mechanisms of this drug resistance. Methods: S. maltophilia isolates were collected from clinical specimens in a university hospital in Northwestern China during the period between 2010 and 2012, and were identified to the species level with a fully automated microbiological system. Antimicrobial susceptibility testing was performed for S. maltophilia with the Kirby-Bauer disc diffusion method. The minimal inhibitory concentrations (MICs) of norfloxacin, ofloxacin, chloramphenicol, minocycline, ceftazidime, levofloxacin and ciprofloxacin against S. maltophilia were assessed using the agar dilution method, and changes in the MIC of norfloxacin, ciprofloxacin and ofloxacin were observed after the addition of reserpine, an efflux pump inhibitor. Fluoroquinolone resistance genes were detected in S. maltophilia using a polymerase chain reaction (PCR) assay, and the expression of efflux pump smeD and smeF genes was determined using a quantitative fluorescent (QF)-PCR assay. Pulsed-field gel electrophoresis (PFGE) was employed to genotype identified S. maltophilia isolates. Results: A total of 426 S. maltophilia strains were isolated from the university hospital from 2010 to 2012, consisting of 10.1% of total non-fermentative bacteria. The prevalence of norfloxacin, ciprofloxacin and ofloxacin resistance was 32.4%, 21.9% and 13.2% in the 114 S. maltophilia isolates collected from 2012, respectively. Following reserpine treatment, 19 S. maltophilia isolates positive for efflux pump were identified, and high expression of smeD and smeF genes was detected in two resistant isolates. gyrA, parC, smeD, smeE and smeF genes were detected in all 114 S. maltophilia isolates, while smqnr gene was found in 25.4% of total isolates. Glu-Lys mutation (GAA-AAA) was detected at the 151th amino acid of the gyrA gene, while Gly-Arg mutation (GGC-CGC) was found at the 37th amino acid of the parC gene. However, no significant difference was observed in the prevalence of gyrA or parC mutation between fluoroquinolone-resistant and -susceptible isolates (p> 0.05). The smqnr gene showed 92% to 99% heterogenicity among the 14 S. maltophilia clinical isolates. PFGE of 29 smqnr gene-positive S. maltophilia clinical isolates revealed 25 PFGE genotypes and 28 subgenotypes. Conclusions: Monitoring the clinical distribution and antimicrobial resistance of S. maltophilia is of great significance for the clinical therapy of bacterial infections. Reserpine is effective to inhibit the active efflux of norfloxacin, ciprofloxacin and ofloxacin on S. maltophilia and reduce MIC of fluoroquinolones against the bacteria. The expression of efflux pump smeD and smeF genes correlates with the resistance of S. maltophilia to fluoroquinolones.
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Affiliation(s)
- Wei Jia
- Medical Experimental Center, General Hospital of Ningxia Medical University, 804 Shengli Street, Yinchuan City, Ningxia Hui Autonomous Region 750004, China.
| | - Jiayuan Wang
- School of Laboratory Medicine, Ningxia Medical University, 1160 Shengli Street, Yinchuan City, Ningxia Hui Autonomous Region 750004, China.
| | - Haotong Xu
- School of Laboratory Medicine, Ningxia Medical University, 1160 Shengli Street, Yinchuan City, Ningxia Hui Autonomous Region 750004, China.
| | - Gang Li
- Medical Experimental Center, General Hospital of Ningxia Medical University, 804 Shengli Street, Yinchuan City, Ningxia Hui Autonomous Region 750004, China.
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De Mauri A, Torreggiani M, Chiarinotti D, Andreoni S, Molinari G, De Leo M. Stenotrophomonas maltophilia: an emerging pathogen in dialysis units. J Med Microbiol 2014; 63:1407-1410. [PMID: 25102909 DOI: 10.1099/jmm.0.076513-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Infection is an important cause of morbidity and mortality among patients with end stage renal disease. Stenotrophomonas maltophilia is an unusual yet emerging pathogen in dialysis units. We performed a systematic PubMed/Medline and Scopus review of peer-reviewed English papers on S. maltophilia infections among patients undergoing chronic dialysis, with regard to vascular accesses, systemic infections and environment contaminations. Moreover, we suggest a treatment algorithm to preserve the patient and the permanent dialysis catheters.
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Affiliation(s)
- Andreana De Mauri
- Nephrology and Dialysis Unit, University Hospital 'Maggiore della Carità', Novara, Italy
| | - Massimo Torreggiani
- Unit of Nephrology and Hemodialysis, IRCCS Fondazione Salvatore Maugeri, University of Pavia, Pavia, Italy
| | - Doriana Chiarinotti
- Nephrology and Dialysis Unit, University Hospital 'Maggiore della Carità', Novara, Italy
| | - Stefano Andreoni
- Microbiology and Virology Laboratory, University Hospital 'Maggiore della Carità', Novara, Italy
| | - Gianlorenzo Molinari
- Microbiology and Virology Laboratory, University Hospital 'Maggiore della Carità', Novara, Italy
| | - Martino De Leo
- Nephrology and Dialysis Unit, University Hospital 'Maggiore della Carità', Novara, Italy
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21
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Baek JH, Kim CO, Jeong SJ, Ku NS, Han SH, Choi JY, Yong D, Song YG, Lee K, Kim JM. Clinical factors associated with acquisition of resistance to levofloxacin in Stenotrophomonas maltophilia. Yonsei Med J 2014; 55:987-93. [PMID: 24954328 PMCID: PMC4075404 DOI: 10.3349/ymj.2014.55.4.987] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Fluoroquinolones, rapidly gaining prominence in treatment of Stenotrophomonas maltophilia (SMP), are noted for their potency and tolerability. However, SMP may rapidly acquire resistance to fluoroquinolones. We evaluated associations of clinical factors with acquisition of levofloxacin resistance (LFr) in SMP. MATERIALS AND METHODS Our retrospective cohort study was based on patient data collected between January 2008 and June 2010. Through screening of 1275 patients, we identified 122 patients with data for SMP antibiotic susceptibility testing in ≥3 serial SMP isolates. RESULTS We assigned the 122 patients to either the SS group (n=54) in which levofloxacin susceptibility was maintained or the SR group (n=31) in which susceptible SMP acquired resistance. In multivariate regression analysis, exposure to levofloxacin for more than 3 weeks [odds ratio (OR) 15.39, 95% confidential interval (CI) 3.08-76.93, p=0.001] and co-infection or co-colonization with Klebsiella pneumoniae resistant to levofloxacin (OR 4.85, 95% CI 1.16-20.24, p=0.030) were independently associated with LFr acquisition in SMP. CONCLUSION Acquisition of LFr during serial sampling of SMP was related to the levofloxacin exposure.
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Affiliation(s)
- Ji Hyeon Baek
- Department of Infectious Disease, Inha University Hospital, Incheon, Korea
| | - Chang Oh Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Soo Ku
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hoon Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Song
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungwon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Can levofloxacin be a useful alternative to trimethoprim-sulfamethoxazole for treating Stenotrophomonas maltophilia bacteremia? Antimicrob Agents Chemother 2013; 58:581-3. [PMID: 24126583 DOI: 10.1128/aac.01682-13] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A retrospective study was conducted to evaluate the efficacy of levofloxacin in the treatment of Stenotrophomonas maltophilia bacteremia. The 30-day mortality rates were similar between the trimerthoprim-sulfamethoxazole (TMP-SMX) and levofloxacin treatment groups. Adverse events related to antibiotics occurred more frequently in patients receiving TMP-SMX, and recurrent bacteremia due to levofloxacin-resistant S. maltophilia strains developed in patients treated with levofloxacin. Our data suggest that levofloxacin can be a useful alternative option for treating S. maltophilia infections.
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Gallelli L, Gioffrè V, Vero G, Gallelli A, Roccia F, Naty S, Pelaia G, Capano A, Loiacono A, De Sarro G, Maselli R. Clarithromycin in the Treatment of Legionella pneumophila Pneumonia Associated with Multiorgan Failure in a Previously Healthy Patient. Clin Drug Investig 2012; 25:485-90. [PMID: 17532691 DOI: 10.2165/00044011-200525070-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- L Gallelli
- Department of Experimental and Clinical Medicine, Chair of Pharmacology, Clinical Pharmacology and Pharmacovigilance Unit, University ‘Magna Graecia’ of Catanzaro, Regional Pharmacovigilance Center, ‘Mater Domini’ University Hospital, Catanzaro, Italy
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Gabani P, Prakash D, Singh OV. Emergence of antibiotic-resistant extremophiles (AREs). Extremophiles 2012; 16:697-713. [PMID: 22907125 DOI: 10.1007/s00792-012-0475-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/02/2012] [Indexed: 12/14/2022]
Abstract
Excessive use of antibiotics in recent years has produced bacteria that are resistant to a wide array of antibiotics. Several genetic and non-genetic elements allow microorganisms to adapt and thrive under harsh environmental conditions such as lethal doses of antibiotics. We attempt to classify these microorganisms as antibiotic-resistant extremophiles (AREs). AREs develop strategies to gain greater resistance to antibiotics via accumulation of multiple genes or plasmids that harbor genes for multiple drug resistance (MDR). In addition to their altered expression of multiple genes, AREs also survive by producing enzymes such as penicillinase that inactivate antibiotics. It is of interest to identify the underlying molecular mechanisms by which the AREs are able to survive in the presence of wide arrays of high-dosage antibiotics. Technologically, "omics"-based approaches such as genomics have revealed a wide array of genes differentially expressed in AREs. Proteomics studies with 2DE, MALDI-TOF, and MS/MS have identified specific proteins, enzymes, and pumps that function in the adaptation mechanisms of AREs. This article discusses the molecular mechanisms by which microorganisms develop into AREs and how "omics" approaches can identify the genetic elements of these adaptation mechanisms. These objectives will assist the development of strategies and potential therapeutics to treat outbreaks of pathogenic microorganisms in the future.
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Affiliation(s)
- Prashant Gabani
- Division of Biological and Health Sciences, University of Pittsburgh, 300 Campus Drive, Bradford, PA 16701, USA
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25
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Samonis G, Karageorgopoulos DE, Maraki S, Levis P, Dimopoulou D, Spernovasilis NA, Kofteridis DP, Falagas ME. Stenotrophomonas maltophilia infections in a general hospital: patient characteristics, antimicrobial susceptibility, and treatment outcome. PLoS One 2012; 7:e37375. [PMID: 22624022 PMCID: PMC3356252 DOI: 10.1371/journal.pone.0037375] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 04/18/2012] [Indexed: 11/25/2022] Open
Abstract
Introduction Stenotrophomonas maltophilia is acquiring increasing importance as a nosocomial pathogen. Methods We retrospectively studied the characteristics and outcome of patients with any type of S. maltophilia infection at the University Hospital of Heraklion, Crete, Greece, between 1/2005–12/2010. S. maltophilia antimicrobial susceptibility was tested with the agar dilution method. Prognostic factors for all-cause in-hospital mortality were assessed with multivariate logistic regression. Results Sixty-eight patients (median age: 70.5 years; 64.7% males) with S. maltophilia infection, not related to cystic fibrosis, were included. The 68 patients were hospitalized in medical (29.4%), surgical (26.5%), hematology/oncology departments (23.5%), or the intensive care units (ICU; 20.6%). The most frequent infection types were respiratory tract (54.4%), bloodstream (16.2%), skin/soft tissue (10.3%), and intra-abdominal (8.8%) infection. The S. maltophilia-associated infection was polymicrobial in 33.8% of the cases. In vitro susceptibility was higher to colistin (91.2%), trimethoprim/sulfamethoxazole and netilmicin (85.3% each), and ciprofloxacin (82.4%). The empirical and the targeted treatment regimens were microbiologically appropriate for 47.3% and 63.6% of the 55 patients with data available, respectively. Most patients received targeted therapy with a combination of agents other than trimethoprim/sulfamethoxazole. The crude mortality and the mortality and the S. maltophilia infection-related mortality were 14.7% and 4.4%, respectively. ICU hospitalization was the only independent prognostic factor for mortality. Conclusion S. maltophilia infection in a general hospital can be associated with a good prognosis, except for the patients hospitalized in the ICU. Combination reigmens with fluoroquinolones, colistin, or tigecycline could be alternative treatment options to trimethoprim/sulfamethoxazole.
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Affiliation(s)
- George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Drosos E. Karageorgopoulos
- Alfa Institute of Biomedical Sciences (AIBS), Marousi, Athens, Greece
- Hellenic Center for Disease Control and Prevention, Marousi, Athens, Greece
| | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Panagiotis Levis
- Alfa Institute of Biomedical Sciences (AIBS), Marousi, Athens, Greece
| | - Dimitra Dimopoulou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | - Matthew E. Falagas
- Alfa Institute of Biomedical Sciences (AIBS), Marousi, Athens, Greece
- Department of Medicine, Henry Dunant Hospital, Athens, Greece
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, United States of America
- * E-mail:
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Wu H, Wang JT, Shiau YR, Wang HY, Lauderdale TLY, Chang SC. A multicenter surveillance of antimicrobial resistance on Stenotrophomonas maltophilia in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2011; 45:120-6. [PMID: 22154599 DOI: 10.1016/j.jmii.2011.09.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/17/2011] [Accepted: 06/29/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen in debilitated hosts. Clinical management of S. maltophilia is challenging due to its intrinsic resistance to a variety of antibiotics. This study investigated the trend and prevalence of antimicrobial resistance in S. maltophilia from a nationwide surveillance study in Taiwan. METHODS S. maltophilia isolates were collected biennially between 1998 and 2008 as part of the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program from medical centers and regional hospitals throughout Taiwan. Minimal inhibitory concentrations (MIC) were determined using the Clinical and Laboratory Standards Institute reference broth microdilution method. RESULTS A total of 377 non-duplicate S. maltophilia isolates were collected from 38 hospitals. The majority of the isolates were from the respiratory tract (256, 67.9%), followed by blood (48, 12.7%). Overall, 376 (99.7%) isolates were susceptible to minocycline, 362 (96%) to tigecycline, 311 (82.5%) to trimethoprim/sulfamethoxazole (TMP-SMX), 300 (79.6%) to levofloxacin, 92 (24.4%) to ceftazidime, and 70 (18.6%) to ticarcillin-clavulanic acid. The MIC(50)/MIC(90) of minocycline, tigecycline, TMP-SMX, levofloxacin, ceftazidime, and ticarcillin-clavulanic acid, were ≤0.5/1 μg/mL, 0.25/1 μg/mL, ≤0.25/8 μg/mL, 1/4 μg/mL, 32/128 μg/mL, and 64/128 μg/mL, respectively. A trend of increased non-susceptibility to levofloxacin (p=0.014) was observed over the 10-year study period. Compared to TMP-SMX-susceptible isolates, TMP-SMX-resistant isolates were less susceptible to levofloxacin (54.5% vs. 84.9%, p<0.001). CONCLUSION In this 10-year study, minocycline and TMP-SMX remained the two antimicrobials with better in vitro activities against S. maltophilia than ceftazidime, levofloxacin, and ticarcillin-clavulanic acid. The activity of levofloxacin against S. maltophilia in Taiwan declined during the past 10 years.
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Affiliation(s)
- Hsiu Wu
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Abbott IJ, Slavin MA, Turnidge JD, Thursky KA, Worth LJ. Stenotrophomonas maltophilia: emerging disease patterns and challenges for treatment. Expert Rev Anti Infect Ther 2011; 9:471-88. [PMID: 21504403 DOI: 10.1586/eri.11.24] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Stenotrophomonas maltophilia is a ubiquitous organism associated with opportunistic infections. In the immunocompromised host, increasing prevalence and severity of illness is observed, particularly opportunistic bloodstream infections and pneumonia syndromes. In this article, the classification and microbiology are outlined, together with clinical presentation, outcomes and management of infections due to S. maltophilia. Although virulence mechanisms and the genetic basis of antibiotic resistance have been identified, a role for standardized and uniform reporting of antibiotic sensitivity is not defined. Infections due to S. maltophilia have traditionally been treated with trimethoprim-sulfamethoxazole, ticarcillin-clavulanic acid, or fluoroquinolone agents. The use of combination therapies, newer fluoroquinolone agents and tetracycline derivatives is discussed. Finally, measures to prevent transmission of S. maltophilia within healthcare facilities are reported, especially in at-risk patient populations.
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Affiliation(s)
- Iain J Abbott
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
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Song JH, Sung JY, Kwon KC, Park JW, Cho HH, Shin SY, Ko YH, Kim JM, Shin KS, Koo SH. [Analysis of acquired resistance genes in Stenotrophomonas maltophilia]. Korean J Lab Med 2010; 30:295-300. [PMID: 20603591 DOI: 10.3343/kjlm.2010.30.3.295] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stenotrophomonas maltophilia is a gram-negative bacillus and a nosocomial pathogen in immunocompromised patients. Trimethoprim/sulfamethoxazole (TMP/SMX) is the drug of choice for treating S. maltophilia infection; however, resistance to TMP/SMX is increasing. In this study, we investigated the relationship between the incidence of TMP/SMX resistance and the presence of sul genes and mobile elements. METHODS A total of 120 S. maltophilia isolates were collected from 3 university hospitals between April 2007 and April 2009. Antimicrobial susceptibilities were determined using the disk diffusion method. PCR and DNA sequencing were conducted for the detection of sul1, sul2, class 1 integron, and ISCR2 element. Repetitive extragenic palindromic sequence-based PCR (REP-PCR) was carried out to evaluate the genetic relatedness. RESULTS The TMP/SMX-resistant (R) isolates harbored a significantly higher proportion of sul1 gene and class 1 integron than TMP/SMX-susceptible (S) isolates (P<0.001). Seventeen of 28 isolates with sul1 also had a class 1 integron, but none of the isolates without sul1 had a class 1 integron. The identified gene cassettes within class 1 integrons include aacA4, aadA1, aac6'-II, and qac. None of the 120 isolates carried sul2, glmM, or ISCR2 element. REP-PCR did not show any genetic relatedness among the isolates. CONCLUSIONS In Korea, the resistance of S. maltophilia isolates to TMP/SMX is due to sul1 within a class 1 integron rather than to sul2. The class 1 integron also harbors multiple antibiotic resistance genes in addition to sul1, and therefore it could mediate multidrug resistance in S. maltophilia.
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Affiliation(s)
- Jeong Hoon Song
- Department of Laboratory Medicine, Chungnam National University, Daejeon, Korea
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Antimicrobial susceptibilities of a worldwide collection of Stenotrophomonas maltophilia isolates tested against tigecycline and agents commonly used for S. maltophilia infections. Antimicrob Agents Chemother 2010; 54:2735-7. [PMID: 20368399 DOI: 10.1128/aac.01774-09] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antimicrobial susceptibilities were determined for 1,586 isolates of Stenotrophomonas maltophilia from globally diverse medical centers using the Clinical Laboratory Standards Institute broth microdilution method. The combination trimethoprim-sulfamethoxazole (96.0% of isolates susceptible at < or =2 microg/ml trimethoprim and 38 microg/ml sulfamethoxazole) and tigecycline (95.5% of isolates sussceptible at < or =2 microg/ml) were the only antimicrobials tested with >94% susceptibility in all regions. Susceptibility rates for other commonly used were lower than expected and varied geographically. This in vitro data supports tigecycline as a potential candidate for clinical investigations into S. maltophilia infections.
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Abstract
BACKGROUND We determined the in vitro activity of 9 synthetic fire ant venom alkaloids (+/-)-solenopsin A, (2R, 6R)-solenopsin A, (2S, 6S)-solenopsin B, (+/-)-isosolenopsin A, (2S, 6R)-isosolenopsin A,(2R, 6S)-isosolenopsin A, (+/-)-isosolenopsin B, (2S, 6R)-isosolenopsin B, and (2R, 6S)-isosolenopsin B against 6 species of bacteria (Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Stenotrophomonas maltophilia, and Pseudomonas aeruginosa). METHODS The minimum inhibitory concentration and minimum bacteriocidal concentration were determined in accordance with the Clinical Laboratory Standards Institute guidelines. Time kill studies used American Type Culture Collection bacterial isolates tested at 5 times the minimum inhibitory concentration. RESULTS None of the venom alkaloids inhibited E. coli or P. aeruginosa, whereas all the alkaloids inhibited S. pneumoniae. Only 4 alkaloids inhibited S. pneumoniae, S. aureus, and S. maltophilia. Time-kill kinetics indicates that all 4 active alkaloids had bactericidal activity. CONCLUSIONS Specific isomers of synthetic fire ant venom alkaloids have antibacterial activity against human pathogens.
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Walsh TJ. Advances and challenges in infectious diseases supportive care of patients with hematologic malignancies, hematopoietic stem cell transplantation, and severe aplastic anemia. Semin Hematol 2009; 46:191-7. [PMID: 19549573 DOI: 10.1053/j.seminhematol.2009.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infectious diseases are important causes of morbidity and mortality in immunocompromised patients with hematological malignancies, severe aplastic anemia (SAA), and myelodysplasia. Major advances in infectious diseases supportive care have been critical to improving the outcome of patients suffering from these life-threatening diseases. Advances in diagnosis, treatment, and prevention of life-threatening infections have reduced morbidity and mortality, improved quality of life, and enabled the use of potentially curative chemotherapy, radiation, hematopoietic stem cell transplantation (HSCT), and immunosuppressive therapy to patients battling these devastating diseases. Despite these advances, the continued development of antimicrobial resistance, emergence of new pathogens, and the evolution of host factors present evolving challenges to the successful management of infectious complications in this expanding patient population.
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Affiliation(s)
- Thomas J Walsh
- Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA
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Looney WJ, Narita M, Mühlemann K. Stenotrophomonas maltophilia: an emerging opportunist human pathogen. THE LANCET. INFECTIOUS DISEASES 2009; 9:312-23. [PMID: 19393961 DOI: 10.1016/s1473-3099(09)70083-0] [Citation(s) in RCA: 346] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen in the debilitated host. S maltophilia is not an inherently virulent pathogen, but its ability to colonise respiratory-tract epithelial cells and surfaces of medical devices makes it a ready coloniser of hospitalised patients. S maltophilia can cause blood-stream infections and pneumonia with considerable morbidity in immunosuppressed patients. Management of infection is hampered by high-level intrinsic resistance to many antibiotic classes and the increasing occurrence of acquired resistance to the first-line drug co-trimoxazole. Prevention of acquisition and infection depends upon the application of modern infection-control practices, with emphasis on the control of antibiotic use and environmental reservoirs.
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Affiliation(s)
- W John Looney
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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Stergiopoulou T, Meletiadis J, Sein T, Papaioannidou P, Tsiouris I, Roilides E, Walsh TJ. Comparative pharmacodynamic interaction analysis between ciprofloxacin, moxifloxacin and levofloxacin and antifungal agents against Candida albicans and Aspergillus fumigatus. J Antimicrob Chemother 2008; 63:343-8. [PMID: 19109335 DOI: 10.1093/jac/dkn473] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients suffering from invasive mycoses often receive concomitant antifungal therapy and antibacterial agents. Ciprofloxacin, a carboxyfluoroquinolone, was previously observed to demonstrate the pharmacodynamic interactions with antifungal agents by altering their growth inhibitory activity against Candida albicans and Aspergillus fumigatus. However, little is known about the interaction between other extended-spectrum fluoroquinolones, such as levofloxacin and moxifloxacin, and antifungal agents against C. albicans and A. fumigatus. METHODS Using a microdilution chequerboard technique, we employed isobolographic analysis adapted to incorporate a non-active agent in order to analyse the potential in vitro interaction between ciprofloxacin, levofloxacin or moxifloxacin and the following representative antifungal agents: amphotericin B, fluconazole or voriconazole and caspofungin. RESULTS Synergistic interactions [interaction indices (Iis) 0.69-0.83, P < 0.05] were observed between amphotericin B (0.07-0.31 mg/L) and either ciprofloxacin (0.19-7.65 mg/L) or levofloxacin (0.41-32.88 mg/L) against C. albicans and A. fumigatus. Synergy (Iis 0.56-0.87, P < 0.05) also was found between voriconazole (0.09-0.14 mg/L) and ciprofloxacin (0.22-11.41 mg/L) as well as between caspofungin (8.94-22.07 mg/L) and levofloxacin (0.14-5.17 mg/L) against A. fumigatus. Some antagonistic (Iis 1.16-1.29, P < 0.05) interactions were observed between fluoroquinolones and fluconazole against C. albicans. In general, ciprofloxacin enhanced the activity of antifungal agents more than moxifloxacin and levofloxacin against both C. albicans and A. fumigatus. CONCLUSIONS The knowledge of the pharmacodynamic interactions between fluoroquinolones and antifungal agents may guide selection and potentially improve the outcome of immunosuppressed patients with concurrent bacterial and fungal infections.
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Affiliation(s)
- Theodouli Stergiopoulou
- Immunocompromised Host Section, Pediatric Oncology Branch, Clinical Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Harada N, Soejima Y, Taketomi A, Yoshizumi T, Uchiyama H, Maehara Y. Stenotrophomonas maltophilia bacteremia after living donor liver transplantation: Report of a case. Surg Today 2008; 38:469-72. [PMID: 18560974 DOI: 10.1007/s00595-007-3622-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 07/18/2007] [Indexed: 10/22/2022]
Abstract
Stenotrophomonas maltophilia (previously named Xanthomonas maltophilia) is an aerobic, nonfermentive, Gram-negative bacillus that is widespread in the environment. It is considered to be an organism with a limited pathogenic potential, which is rarely capable of causing diseases in humans other than in those who are in an immunocompromised state. In this study, we outline the case of a patient with Stenotrophomonas maltophilia bacteremia after living donor liver transplantation, which showed the clinical signs of severe sepsis and was resistant to almost all antibiotics. However, we successfully treated the patient with the antibiotics trimethoprim-sulfamethoxazole (TMP/SMX) and minocycline hydrochloride (MINO), and performed endotoxin-absorbing therapy using polymyxin B (PMX) to remove the endotoxin from Gram-negative bacillus as well as continuous hemodiafiltration (CHDF) to remove inflammatory cytokines. To the best of our knowledge, this is the first report on the treatment of Stenotrophomonas maltophilia bacteremia after living donor liver transplantation.
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Affiliation(s)
- Noboru Harada
- Department of Surgery and Medical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Nicodemo AC, Paez JIG. Antimicrobial therapy for Stenotrophomonas maltophilia infections. Eur J Clin Microbiol Infect Dis 2008; 26:229-37. [PMID: 17334747 DOI: 10.1007/s10096-007-0279-3] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Stenotrophomonas maltophilia has emerged as an important nosocomial pathogen capable of causing respiratory, bloodstream, and urinary infections. The treatment of nosocomial infections by S. maltophilia is difficult, as this pathogen shows high levels of intrinsic or acquired resistance to different antimicrobial agents, drastically reducing the antibiotic options available for treatment. Intrinsic resistance may be due to reduced outer membrane permeability or to the multidrug efflux pumps. However, specific mechanisms of resistance such as aminoglycoside-modifying enzymes or the heterogeneous production of metallo-beta-lactamase have contributed to the multidrug-resistant phenotype displayed by this pathogen. Moreover, the lack of standardized susceptibility tests and their interpretative criteria hinder the choice of an adequate antibiotic treatment. Recommendations for the treatment of infections by S. maltophilia are based on in vitro studies, certain nonrandomized clinical trials, and anecdotal experience. Trimethoprim-sulfamethoxazole remains the drug of choice, although in vitro studies indicate that ticarcillin-clavulanic acid, minocycline, some of the new fluoroquinolones, and tigecycline may be useful agents. This review describes the main resistance mechanisms, the in vitro susceptibility profile, and treatment options for S. maltophilia infections.
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Affiliation(s)
- A C Nicodemo
- Department of Infectious Diseases, University of São Paulo Medical School, São Paulo, SP, Brazil.
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Wolfaardt G, Hendry M, Birkham T, Bressel A, Gardner M, Sousa A, Korber D, Pilaski M. Microbial response to environmental gradients in a ceramic-based diffusion system. Biotechnol Bioeng 2008; 100:141-9. [DOI: 10.1002/bit.21736] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Rodríguez C, Wachlin A, Altendorf K, García F, Lipski A. Diversity and antimicrobial susceptibility of oxytetracycline-resistant isolates of Stenotrophomonas sp. and Serratia sp. associated with Costa Rican crops. J Appl Microbiol 2007; 103:2550-60. [PMID: 18045439 DOI: 10.1111/j.1365-2672.2007.03496.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To ameliorate the identification, evaluate the diversity, and determine the antimicrobial sensitivity of 19 oxytetracycline-resistant isolates of Stenotrophomonas sp. and Serratia sp. associated with Costa Rican crops. METHODS AND RESULTS Phenotypical, chemotaxonomical, and molecular data allocated most isolates to the species Sten. maltophilia and Ser. marcescens. The API profiles, antimicrobial resistance patterns (ATB system), and BOX-polymerase chain reaction (PCR) genomic fingerprints of isolates of Stenotrophomonas sp. exhibited a higher degree of heterogeneity than those obtained for the isolates of Serratia sp. The former group of bacteria exhibited multiresistance to antimicrobials. In contrast, isolates of Serratia sp. were sensitive to the majority of the drugs tested. Changes in the results of the antibiograms throughout incubation, which indicate an induction of tolerance, were observed for isolates of both the species. Minimum inhibitory concentration of oxytetracycline, determined using E-test stripes, were rather elevated. CONCLUSIONS The occurrence of two species of opportunistic pathogens in crop-associated materials poses a risk to consumers in the community. SIGNIFICANCE AND IMPACT OF THE STUDY The phenotypic and genotypic data presented could support epidemiologist and physicians dealing with infections caused by environmental strains of these taxa.
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Affiliation(s)
- C Rodríguez
- Abteilung Mikrobiologie, Fachbereich Biologie/Chemie, Universität Osnabrück, Barbarastrasse 11, Osnabrück, Germany.
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Ansari SR, Hanna H, Hachem R, Jiang Y, Rolston K, Raad I. Risk factors for infections with multidrug-resistantStenotrophomonas maltophilia in patients with cancer. Cancer 2007; 109:2615-22. [PMID: 17487860 DOI: 10.1002/cncr.22705] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stenotrophomonas maltophilia is responsible for an increasing number of infections, especially in hospitalized patients. Therapy options are limited and trimethoprim/sulfamethoxazole (TMP/SMX) is often the main treatment option for this infection. In the current study, the risk factors were determined for the emergence of multidrug-resistant (MDR) S. maltophilia. METHODS A case-control study was conducted to determine risk factors for the development of MDR S. maltophilia in cancer patients. The case group was composed of patients treated at the University of Texas M. D. Anderson Cancer Center for MDR S. maltophilia between 1996 and 2004 (n = 54). Two control groups were used: patients at comparable risk for S. maltophilia (C-controls) and patients with S. maltophilia infection that was susceptible to TMP-SMX and at least 2 other antibiotics (ciprofloxacin, ceftazidime, amikacin, and ticarcillin/clavulanate) (S-controls). RESULTS When compared with C-controls, prior use of carbapenems or quinolones and admission to an intensive care unit within 30 days of isolation of the pathogen were found to be independently associated with MDR S. maltophilia infection (P < .02), as was an increased overall mortality rate (P = .04). When compared with S-controls, risk factors were history of S. maltophilia infection during the prior year and prior use of TMP-SMX (P = .015). CONCLUSIONS Judicious use of TMP-SMX, carbapenems, and quinolones is necessary to control the risk for MDR S. maltophilia infection.
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Affiliation(s)
- Shoaib R Ansari
- Department of Infectious Diseases, Infection Control, and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Landrum ML, Conger NG, Forgione MA. Trimethoprim-sulfamethoxazole in the treatment of Stenotrophomonas maltophilia osteomyelitis. Clin Infect Dis 2006; 40:1551-2. [PMID: 15844086 DOI: 10.1086/429730] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Giordano A, Magni A, Trancassini M, Varesi P, Turner R, Mancini C. Identification of respiratory isolates of Stenotrophomonas maltophilia by commercial biochemical systems and species-specific PCR. J Microbiol Methods 2006; 64:135-8. [PMID: 15927289 DOI: 10.1016/j.mimet.2005.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Revised: 04/15/2005] [Accepted: 04/18/2005] [Indexed: 11/22/2022]
Abstract
One hundred strains of Stenotrophomonas maltophilia isolates from respiratory specimens were biochemically identified using the API 20NE strip and the VITEK2 ID-GNB card. The identification was confirmed by a species-specific PCR using two primers specific for the 23S rRNA gene. The API 20NE showed only 1 strain with "low discrimination" whereas the VITEK2 gave 12. In any case, the two biochemical systems showed good reliability compared to SS-PCR.
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Affiliation(s)
- A Giordano
- Dipartimento di Scienze di Sanità Pubblica Sezione di Microbiologia Università degli Studi di Roma La Sapienza, Via M. Fascetti, 67, 00136 Rome, Italy.
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Gülmez D, Hasçelik G. Stenotrophomonas maltophilia: antimicrobial resistance and molecular typing of an emerging pathogen in a Turkish university hospital. Clin Microbiol Infect 2005; 11:880-6. [PMID: 16216102 DOI: 10.1111/j.1469-0691.2005.01257.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite its limited pathogenicity, Stenotrophomonas maltophilia is an emerging nosocomial pathogen. This study investigated the isolation frequency, antimicrobial resistance and genotypic relationships of 205 S. maltophilia isolates from 188 patients in a university hospital between 1998 and 2003. Susceptibility profiles for 11 antimicrobial agents were determined by the NCCLS agar dilution method for non-fermentative bacteria, while enterobacterial repetitive intergenic consensus sequence (ERIC)-PCR and pulsed-field gel electrophoresis (PFGE) were used for genotyping of the isolates. Of the 205 isolates, 56.1% were isolated in the last 2 years of the study. The risk of S. maltophilia isolation was higher in intensive care units, S. maltophilia was isolated mostly (86.8%) after hospitalisation for >or= 48 h, and 90.4% of the patients had underlying diseases. Resistance levels were>60% for all antimicrobial agents tested except co-trimoxazole. High genetic diversity was found among the S. maltophilia isolates, and cross-infection with S. maltophilia was not common. Although ERIC-PCR revealed fewer genotypes than PFGE, it proved to be a rapid and easy method for S. maltophilia genotyping, and was more economical than PFGE.
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Affiliation(s)
- D Gülmez
- Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Zelenitsky SA, Iacovides H, Ariano RE, Harding GKM. Antibiotic combinations significantly more active than monotherapy in an in vitro infection model of Stenotrophomonas maltophilia. Diagn Microbiol Infect Dis 2005; 51:39-43. [PMID: 15629227 DOI: 10.1016/j.diagmicrobio.2004.09.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Accepted: 09/03/2004] [Indexed: 11/28/2022]
Abstract
The goal of this study was to investigate clinical doses of trimethoprim-sulfamethoxazole (TMP-SMX) alone and in combination against Stenotrophomonas maltophilia in an in vitro pharmacodynamic infection model. A 1-compartment model was established using 4 clinical isolates of S. maltophilia susceptible to TMP-SMX and susceptible or intermediately susceptible to at least one other agent (ie, ceftazidime, ciprofloxacin, gentamicin, tobramycin). Antibiotics alone and in combination were tested by simulating unbound serum concentration profiles achieved with multiple-dose regimens in humans. Despite susceptible minimum inhibitory concentrations, TMP-SMX alone was bacteriostatic at best against all isolates. All antibiotic combinations were more active than monotherapy as determined by bacterial reductions at both 24 and 48 h (P < 0.0001). Significant benefit was observed even with agents inactive alone or only intermediately susceptible based on minimum inhibitory concentrations. These preclinical data support further investigation of antibiotic combinations in the management of serious S. maltophilia infections.
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Periyannan G, Shaw PJ, Sigdel T, Crowder MW. In vivo folding of recombinant metallo-beta-lactamase L1 requires the presence of Zn(II). Protein Sci 2004; 13:2236-43. [PMID: 15238636 PMCID: PMC2279831 DOI: 10.1110/ps.04742704] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Metallo-beta-lactamase L1, secreted by pathogenic Stenotrophomonas maltophilia, is a dinuclear Zn(II)-containing enzyme that hydrolyzes almost all known penicillins, cephalosporins, and carbapenems. The presence of Zn(II) ions in both metal binding sites is essential for full enzymatic activity; however, the mechanism of physiological metal incorporation is unknown. To probe metal incorporation, L1 was over-expressed in minimal media with (mmL1+Zn) and without (mmL1-Zn) Zn(II) added to the media, and the resulting proteins were purified and characterized. The mmL1+Zn sample was bound by a Q-Sepharose column, exhibited steady-state kinetic properties, bound Zn(II), existed as a tetramer, and yielded fluorescence emission and CD spectra similar to L1 overexpressed in rich media. On the other hand, the mmL1-Zn sample did not bind to a Q-Sepharose column, and gel filtration studies demonstrated that this protein was monomeric. The mmL1-Zn sample exhibited a lower kcat value, bound less Zn(II), and yielded fluorescence emission and CD spectra consistent with this enzyme being folded improperly. Taken together, these data demonstrate that the proper folding of L1 requires the presence of Zn(II) and suggest that in vitro, thermodynamic metal binding studies do not accurately reflect physiological metal incorporation into L1.
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Affiliation(s)
- Gopalraj Periyannan
- Miami University, Department of Chemistry and Biochemistry, Oxford, Ohio 45056, USA
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Ba BB, Feghali H, Arpin C, Saux MC, Quentin C. Activities of ciprofloxacin and moxifloxacin against Stenotrophomonas maltophilia and emergence of resistant mutants in an in vitro pharmacokinetic-pharmacodynamic model. Antimicrob Agents Chemother 2004; 48:946-53. [PMID: 14982788 PMCID: PMC353051 DOI: 10.1128/aac.48.3.946-953.2004] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A two-compartment in vitro pharmacokinetic-pharmacodynamic model, with full computer-controlled devices, was used to accurately simulate human plasma pharmacokinetic profiles after multidose oral regimens of ciprofloxacin (750 mg every 12 h) and moxifloxacin (400 mg every 24 h) during 48 h. Pharmacodynamics of these drugs was investigated against three quinolone-susceptible strains of Stenotrophomonas maltophilia (MICs of ciprofloxacin and moxifloxacin of 0.5 to 2 and 0.0625 to 0.5 microg/ml, respectively). The first dose of ciprofloxacin and moxifloxacin reduced the bacterial count by 1 and 2 log CFU/ml, respectively, prior to a bacterial regrowth that reached the plateau value of the growth control curve at 13 to 24 h versus 24 to 36 h and persisted despite repeated administration of both drugs. The surviving bacterial cells were quinolone-resistant mutants (2 to 128 times the MIC) that exhibited cross-resistance to unrelated antibiotics. Their antibiotic resistance probably resulted from the overproduction of different multidrug resistance efflux system(s). C(max)/MIC and area under the concentration-time curve from 0 to 24 h (AUC(0-24))/MIC values were at least threefold higher for moxifloxacin than for ciprofloxacin. Moreover, integral parameters of ciprofloxacin and moxifloxacin, in particular the area under the killing and regrowth curve from 0 to 48 h (AUBC(0-48), 342.3 to 401.3 versus 295.2 to 378.7 h x log CFU/ml, respectively) and the area between the control growth curve and the killing and regrowth curve from 0 to 48 h (ABBC(0-48), 40.4 to 101.1 versus 72.9 to 144.7 h x log CFU/ml, respectively), demonstrated a better antibacterial effect of moxifloxacin than ciprofloxacin on S. maltophilia. However, selection of resistant mutants by both fluoroquinolones, although delayed with moxifloxacin, emphasizes the need to use maximal dosages and combined therapy in the treatment of systemic S. maltophilia infections.
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Affiliation(s)
- Boubakar B Ba
- Laboratoire de Pharmacocinétique et de Pharmacie Clinique, France.
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Valdezate S, Vindel A, Martín-Dávila P, Del Saz BS, Baquero F, Cantón R. High genetic diversity among Stenotrophomonas maltophilia strains despite their originating at a single hospital. J Clin Microbiol 2004; 42:693-9. [PMID: 14766838 PMCID: PMC344440 DOI: 10.1128/jcm.42.2.693-699.2003] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The levels of genetic relatedness of 139 Stenotrophomonas maltophilia strains recovered from 105 hospitalized non-cystic fibrosis patients (51% from medical wards, 35% from intensive care units, and 14% from surgical wards) and 7 environmental sources in the same hospital setting during a 4-year period were typed by the pulsed-field gel electrophoresis (PFGE) technique. A total of 99 well-defined distinct XbaI PFGE patterns were identified (Simpson's discrimination index, 0.996). The dendrogram showed a Dice similarity coefficient ranging from 28 to 80%. Two major clusters (I and II), three minor clusters (III, IV, and V), and two independent branches were observed when using a 36% Dice coefficient, indicating a high diversity of genetic relatedness. It is of note that 84% of strains were grouped within two major clonal lineages. No special cluster gathering was found among strains belonging to the same sample type specimen, patients' infection or colonization status, and ward of precedence. Despite this fact, three different clones (A, B, and C) recovered from respiratory samples from six, three, and two patients, respectively, and two clones, D and E, in two bacteremic patients each, were identified. Isolation of an S. maltophilia strain belonging to the clone A profile in a bronchoscope demonstrated a common source from this clone. This study revealed a high genetic diversity of S. maltophilia isolates despite their origin from a single hospital, which may be related to the wide environmental distribution of this pathogen. However, few clones could be transmitted among different patients, yielding outbreak situations.
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Affiliation(s)
- Sylvia Valdezate
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
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Mercuri PS, Ishii Y, Ma L, Rossolini GM, Luzzaro F, Amicosante G, Franceschini N, Frere JM, Galleni M. Clonal diversity and metallo-beta-lactamase production in clinical isolates of Stenotrophomonas maltophilia. Microb Drug Resist 2003; 8:193-200. [PMID: 12363008 DOI: 10.1089/107662902760326904] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Stenotrophomonas maltophilia is a nosocomial pathogen with an intrinsic broad-spectrum resistance to beta-lactam compounds and other antibacterial agents. It produces two chromosomal beta-lactamases: a clavulanic acid-sensitive class A (L2) and a tetrameric carbapenemase (L1 or BlaS). We screened 40 S. maltophilia multidrug-resistant clinical isolates recovered between 1995 and 1998 in the Varese Hospital (Italy) for the presence of the metallo-beta-lactamase. The isolates were investigated by phenotypic profiling (enzymatic activity and antibiotic resistance pattern) and molecular methods such as PCR and pulsed-field gel electrophoresis (PFGE) to reveal intraspecies diversity. For the tested S. maltophilia strains, we showed that the beta-lactamase production could be induced by the presence of imipenem (50 microg/ml) in the culture media. Addition of 1 mM dipicolinic acid completely inhibited the hydrolysis of imipenem but decreased that nitrocefin in a strain-dependent manner. Full activity of crude extract towards imipenem could be restored by addition of 1 mM ZnCl2. Finally, the gene encoding the carbapenem-hydrolyzing beta-lactamase from S. maltophilia ULA-511 and 39/95, a clinical strain, were isolated and sequenced. These two strains have a different profile of multidrug resistance. The two metallo-beta-lactamases were found to be isologous. The difference of sensitivity of these two strains was associated to the level of production of the metallo-beta-lactamase.
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Martínez JL, Baquero F. Interactions among strategies associated with bacterial infection: pathogenicity, epidemicity, and antibiotic resistance. Clin Microbiol Rev 2002; 15:647-79. [PMID: 12364374 PMCID: PMC126860 DOI: 10.1128/cmr.15.4.647-679.2002] [Citation(s) in RCA: 291] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Infections have been the major cause of disease throughout the history of human populations. With the introduction of antibiotics, it was thought that this problem should disappear. However, bacteria have been able to evolve to become antibiotic resistant. Nowadays, a proficient pathogen must be virulent, epidemic, and resistant to antibiotics. Analysis of the interplay among these features of bacterial populations is needed to predict the future of infectious diseases. In this regard, we have reviewed the genetic linkage of antibiotic resistance and bacterial virulence in the same genetic determinants as well as the cross talk between antibiotic resistance and virulence regulatory circuits with the aim of understanding the effect of acquisition of resistance on bacterial virulence. We also discuss the possibility that antibiotic resistance and bacterial virulence might prevail as linked phenotypes in the future. The novel situation brought about by the worldwide use of antibiotics is undoubtedly changing bacterial populations. These changes might alter the properties of not only bacterial pathogens, but also the normal host microbiota. The evolutionary consequences of the release of antibiotics into the environment are largely unknown, but most probably restoration of the microbiota from the preantibiotic era is beyond our current abilities.
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Affiliation(s)
- José L Martínez
- Departamento de Biotecnología Microbiana, Centro Nacional de Biotecnología. Servicio de Microbiología, Hospital Ramón y Cajal, Madrid, Spain.
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Abstract
The science of pharmacodynamics analyzes the relationship between an antimicrobial's bactericidal effects and its pharmacokinetics. Ideally, randomized and well-controlled clinical trials are the best way to determine pharmacodynamic properties. However, in vitro models that recapitulate in vivo drug clearance profiles represent an increasingly important technology for carrying out pharmacodynamic studies in a more cost-effective, timely, and easily controlled fashion. Although in vitro pharmacodynamic models cannot incorporate all variables seen in vivo, they do provide valuable information for the drug development process and the determination of optimal dosing regimens.
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Affiliation(s)
- R L White
- College of Pharmacy, Medical University of South Carolina, Charleston 29425, USA
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Krueger TS, Clark EA, Nix DE. In vitro susceptibility of Stenotrophomonas maltophilia to various antimicrobial combinations. Diagn Microbiol Infect Dis 2001; 41:71-8. [PMID: 11687317 DOI: 10.1016/s0732-8893(01)00281-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stenotrophomonas maltophilia has emerged as a significant pathogen in compromised patients, causing infections which are difficult to treat. Clinical isolates from patients in the Tucson area were tested against single and combination antibiotics using three testing methods. Ticarcillin/clavulanate, trimethoprim/sulfamethoxazole and trovafloxacin provided comparable inhibitory activity, in vitro. Ciprofloxacin, imipenem and ticarcillin were active less often. Agreements between disk diffusion and broth microdilution results were poor for ciprofloxacin and trimethoprim/sulfamethoxazole; however, agreement was > or = 90% for the other drugs tested. Major or very major errors were observed with ticarcillin, ticarcillin/clavulanate, and trovafloxacin. The addition of aztreonam to ticarcillin/clavulanate enhanced the activity compared to ticarcillin/clavulanate alone using the double-disk diffusion, broth microdilution (checkerboard), and time-kill testing methods. Trovafloxacin exhibited good activity by all three methods, with bactericidal activity at > or = 2x MIC. These results indicate that the newer fluoroquinolones or the triple combination of ticarcillin/clavulanate plus aztreonam may be potential options for treatment of infection caused by S. maltophilia in patients who are intolerant to or fail trimethoprim/sulfamethoxazole therapy.
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Affiliation(s)
- T S Krueger
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, PO Box 210207, 1703 E. Mabel St., Tucson, Arizona 85721, USA
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Micozzi A, Venditti M, Monaco M, Friedrich A, Taglietti F, Santilli S, Martino P. Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies. Clin Infect Dis 2000; 31:705-11. [PMID: 11017819 DOI: 10.1086/314043] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/1999] [Revised: 02/08/2000] [Indexed: 11/03/2022] Open
Abstract
Predisposing factors, clinical characteristics, and antimicrobial treatment of 37 hematology patients with Stenotrophomonas maltophilia bacteremia who were seen at the department of hematology of the University La Sapienza (Rome) from 1987 to 1996 were evaluated. The results were compared with a control group of patients with Pseudomonas aeruginosa bacteremia. Profound neutropenia was more prolonged in the S. maltophilia group (P=.025), severe cellulitis occurred only in S. maltophilia-infected patients (11 [30%]; P=.0002), and the bacteremia presented as breakthrough infection in 56% of the cases due to S. maltophilia (vs. only 24% of those due to P. aeruginosa; P=.002). Acute mortality rates associated with S. maltophilia and P. aeruginosa bacteremia were 24% and 21%, respectively. In both groups, profound neutropenia and hypotension at the onset of bacteremia, duration of profound neutropenia during bacteremia, severity-of-illness score > or =4, and inappropriate antibacterial treatment were factors significantly associated with death. Most S. maltophilia isolates were resistant to aminoglycosides, beta-lactams, and ciprofloxacin. Cotrimoxazole and ticarcillin-clavulanic acid showed borderline activity. Prompt administration of in vitro-active antibiotics may improve the prognosis of S. maltophilia bacteremia, especially for immunocompromised patients, and novel drug combinations are needed for the treatment of severe infections.
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Affiliation(s)
- A Micozzi
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Sezione di Ematologia, Università La Sapienza, 00161 Rome, Italy.
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