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Mendes ET, Paez JIG, Ferraz JR, Marchi AP, Silva ILAFE, Batista MV, de Lima ALM, Rossi F, Levin AS, Costa SF. Clinical and microbiological characteristics of patients colonized or infected by Stenotrophomonas maltophilia : is resistance to sulfamethoxazole/trimethoprim a problem? Rev Inst Med Trop Sao Paulo 2020; 62:e96. [PMID: 33295480 PMCID: PMC7723352 DOI: 10.1590/s1678-9946202062096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen in the last decade. Increased resistance to sulfamethoxazole/trimethoprim (SMX/TMP) has been reported in S. maltophilia strains in the past few years, leading to few therapeutic options. We conducted a prospective multicenter study at two Brazilian teaching hospitals that identified S. maltophilia isolates and evaluated their antimicrobial susceptibility profile, SMX/TMP resistance genes and their clonality profile. A total of 106 non-repeated clinical samples of S. maltophilia were evaluated. Resistance to SMX/TMP was identified in 21.6% of the samples, and previous use of SMX/TMP occurred in 19 (82.6%). PCR detected the sul1 gene in 14 of 106 strains (13.2%). Of these isolates, nine displayed resistance to SMX/TMP. The resistant strains presented a polyclonal profile. This opportunistic pathogen has emerged in immunocompromised hosts, with few therapeutic options, which is aggravated by the description of emerging resistance mechanisms, although with a polyclonal distribution profile.
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Affiliation(s)
- Elisa Teixeira Mendes
- Pontifícia Universidade Católica de Campinas, Programa de
Pós-Graduação em Ciências da Vida, Campinas, São Paulo, Brazil
| | - Jorge Isaac Garcia Paez
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Laboratório de Protozoologia, Bacteriologia e Resistência
Antimicrobiana (LIM 49), São Paulo, São Paulo, Brazil
| | - Juliana Rosa Ferraz
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Laboratório de Protozoologia, Bacteriologia e Resistência
Antimicrobiana (LIM 49), São Paulo, São Paulo, Brazil
| | - Ana Paula Marchi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Laboratório de Protozoologia, Bacteriologia e Resistência
Antimicrobiana (LIM 49), São Paulo, São Paulo, Brazil
| | | | - Marjorie Vieira Batista
- Hospital do Câncer A. C. Camargo, Departamento de Controle de
Infecção, São Paulo, São Paulo, Brazil
| | - Ana Lucia Munhoz de Lima
- Universidade de São Paulo, Faculdade de Medicina, Departamento
de Ortopedia e Traumatologia, São Paulo, São Paulo, Brazil
| | - Flávia Rossi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Laboratório Central, Divisão de Microbiologia, São Paulo, São Paulo,
Brazil
| | - Anna Sara Levin
- Universidade de São Paulo, Faculdade de Medicina, Departamento
de Moléstias Infecciosas, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Laboratório Central, Divisão de Microbiologia, São Paulo, São Paulo,
Brazil
| | - Silvia Figueiredo Costa
- Universidade de São Paulo, Faculdade de Medicina, Departamento
de Moléstias Infecciosas, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Laboratório Central, Divisão de Microbiologia, São Paulo, São Paulo,
Brazil
- Universidade de São Paulo, Instituto de Medicina Tropical de São
Paulo, Divisão Científica, São Paulo, São Paulo, Brazil
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Rizek CF, Jonas D, Garcia Paez JI, Rosa JF, Perdigão Neto LV, Martins RR, Moreno LZ, Rossi Junior A, Levin AS, Costa SF. Multidrug-resistant Stenotrophomonas maltophilia: Description of new MLST profiles and resistance and virulence genes using whole-genome sequencing. J Glob Antimicrob Resist 2018; 15:212-214. [PMID: 30036694 DOI: 10.1016/j.jgar.2018.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Stenotrophomonas maltophilia is an opportunistic pathogen that has high intrinsic and acquired antimicrobial resistance, with great genetic diversity. The aim of this study was to characterise four S. maltophilia clinical isolates displaying different susceptibility profiles using whole-genome sequencing. METHODS The whole genomes of four clinical isolates of S. maltophilia from three patients were sequenced using Ion Torrent™ PGM technology. The isolates presented different susceptibilities to trimethoprim/sulfamethoxazole (SXT) and levofloxacin. RESULTS Three new multilocus sequence typing (MLST) profiles were identified (ST144, ST172 and ST173), differing in virulence and resistance genes. The ST172 isolate had more genes related to toxins than related to motility or adhesion and had different types of efflux pumps than the other isolates. The SXT-resistant strains belonged to ST172 or ST144 and did not harbour the sul1, sul2 or dfrA resistance genes. Strains I and II, from the same patient and belonging to the same ST but differing in resistance to SXT, had all of the resistance genes searched for in common, except for the SmeABC efflux pump complex genes that were only found in the SXT-resistant strain. All strains, including the strain susceptible to levofloxacin, harboured the qnrB gene, which may question the importance of this gene in determining levofloxacin resistance in S. maltophilia. CONCLUSION Here we describe three new MLST profiles. Resistance to SXT in these strains appears to be associated with efflux pumps.
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Affiliation(s)
- Camila Fonseca Rizek
- LIM-54, Tropical Medicine Institute, Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54, Hospital Das Clínicas FMUSP, São Paulo, SP, Brazil.
| | - Daniel Jonas
- Department of Environmental Health Sciences, University Medical Center Freiburg, Freiburg, Germany
| | - Jorge Isaac Garcia Paez
- LIM-54, Tropical Medicine Institute, Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54, Hospital Das Clínicas FMUSP, São Paulo, SP, Brazil
| | - Juliana Ferraz Rosa
- LIM-54, Tropical Medicine Institute, Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54, Hospital Das Clínicas FMUSP, São Paulo, SP, Brazil
| | - Lauro Vieira Perdigão Neto
- LIM-54, Tropical Medicine Institute, Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54, Hospital Das Clínicas FMUSP, São Paulo, SP, Brazil
| | - Roberta Ruedas Martins
- LIM-54, Tropical Medicine Institute, Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54, Hospital Das Clínicas FMUSP, São Paulo, SP, Brazil
| | - Luisa Z Moreno
- Laboratory of Molecular Epidemiology and Antimicrobial Resistance, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil
| | - Alfio Rossi Junior
- Instituto da Criança do Hospital das Clinicas da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Anna S Levin
- LIM-54, Tropical Medicine Institute, Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54, Hospital Das Clínicas FMUSP, São Paulo, SP, Brazil
| | - Silvia Figueiredo Costa
- LIM-54, Tropical Medicine Institute, Department of Infectious Diseases, University of São Paulo, Laboratory of Medical Investigation 54, Hospital Das Clínicas FMUSP, São Paulo, SP, Brazil.
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