Clinical and microbiological characteristics of patients colonized or infected by Stenotrophomonas maltophilia: is resistance to sulfamethoxazole/trimethoprim a problem?

Mendes, Elisa Donalísio Teixeira; Páez, Jorge Isaac García; Ferraz, Juliana Rosa; Marchi, Ana Paula; Silva, Ivan Leonardo Avelino França e; Batista, Marjorie Vieira; Lima, Ana Lucia Munhoz; Rossi, Flávia; Levin, Anna S.; Costa, Sílvia Figueiredo

doi:10.1590/s1678-9946202062096

Cited by 7 publications

(5 citation statements)

References 17 publications

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“…[ 19 , 30 ] A study conducted at 1 hospital in Brazil reported 68.8% susceptibility for respiratory samples and 81.9% for non-respiratory samples. [ 31 ] Another interesting result of our study was that the number of isolates was higher in general ward than that of ICU. That’s probably because the absolute number of patients admitted to the ICU was smaller than that to the general ward.…”

Section: Discussionmentioning

confidence: 74%

A 20-year trend of prevalence and susceptibility to trimethoprim/sulfamethoxazole of Stenotrophomonas maltophilia in a single secondary care hospital in Korea

et al. 2023

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Stenotrophomonas maltophilia is a Gram-negative opportunistic pathogen that can cause serious infection. We aimed to analyze the prevalence and susceptibility rates to trimethoprim/sulfamethoxazole of S. maltophilia. We conducted a retrospective study of S. maltophilia isolates from a university hospital from 2001 to 2020. Clinical information, the numbers of isolates and susceptibility rates were analyzed by year. Susceptibility rates and changes in respiratory and non-respiratory samples were compared. 1805 S. maltophilia isolates were identified, of which 81.4% (1469/1805) were from respiratory samples. There was a male predominance and 52% of the isolates were from general wards. The average susceptibility rate was 87.7% and there was no significant annual trend (P = .519). The susceptibility rate was 88.7% in respiratory samples and 84.1% in non-respiratory samples (P = .018). Susceptibility analyses using clinical data over long periods can guide the choice of antimicrobials especially for pathogen whose treatment options are limited.

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Section: Discussionmentioning

confidence: 74%

A 20-year trend of prevalence and susceptibility to trimethoprim/sulfamethoxazole of Stenotrophomonas maltophilia in a single secondary care hospital in Korea

et al. 2023

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“…There is a concern about the rising antimicrobial resistance of SXT and FQs among S. maltophilia strains. Recent data reveals that the rate of SXT resistance ranges from 9.7% to 21.6% (13,14,23,24). Levofloxacin resistance is also concerning due to the increased use of FQs and changes from 9.7% to 24% in different studies (14,23,24).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, treatment options are limited and clinical data on optimal treatment regimens are lacking. Trimethoprim-sulfamethoxazole (SXT) is accepted as the firstline treatment option for S. maltophilia; however, adverse effects and antimicrobial resistance can limit its use in some patients (13). Fluoroquinolones (FQs) are suggested as alternative regimens for the treatment of bacteremia.…”

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confidence: 99%

Stenotrophomonas maltophilia Bacteremia: From Diagnosis to Treatment

Yıldız

Habibi

et al. 2022

Infect Dis Clin Microbiol

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Objective: There are many difficulties in diagnosing and treating Stenotrophomonas maltophilia bacteremia. In this study, we aimed to evaluate “true” and “false-positive bacteremia” and assess mortality risk factors and the impact of different treatment regimens. Materials and Methods: Hospitalized adult patients with S. maltophilia-positive blood cultures were assessed by a two-stage analysis. First, the clinical significance of blood cultures was assessed, and patients were divided into “true” and “false-positive bacteremia” groups. Then, excluding false positives, we analyzed the antimicrobial regimens and the factors associated with 28-day mortality in true bacteremia cases performing univariate and multivariate analyses. Results: The study included 127 out of 138 patients with S. maltophilia bacteremia. True bacteremia was identified in 51.2% and false-positive bacteremia in 48.8% of patients. In the true bacteremia group, hypotension, nosocomial bacteremia, concomitant infections, a source of bacteremia, two positive blood culture sets, and 28-day mortality were more common. The 28-day mortality was 50.7% among true bacteremia cases. In multivariate analysis, age and solid tumor were the independent predictors of 28-day mortality. Early effective antimicrobial therapy and different antimicrobial regimens, including trimethoprim-sulfamethoxazole (SXT), fluoroquinolones (FQs), and tigecycline (TGC), did not have any significant impact on survival. Conclusion: Patients with S. maltophilia bacteremia should first be assessed regarding clinical significance. Clinical findings, the presence of multiple positive blood culture sets and the primary sources of bacteremia are useful parameters while discriminating true from false-positive bacteremia. Patients with advanced age and solid tumors should be followed carefully in terms of mortality. Antimicrobial regimens, including SXT, FQs, or TGC, can be preferred in patients with S. maltophilia bacteremia considering antimicrobial resistance and adverse effects or toxicity. Keywords: Stenotrophomonas maltophilia, true bacteremia, false-positive bacteremia, blood contamination, mortality, treatment

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“…The rates of susceptibility of S. maltophilia to antimicrobial agents reported during 2020–2022 are listed in Table 2[28–30,39,49,95–120]. TMP-SMZ is the current treatment of choice for S. maltophilia infections because of its good in vitro susceptibility rates and extensive use in clinical settings.…”

Section: Treatment Options For Stenotrophomonas Maltophilia Infectionsmentioning

confidence: 99%

Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis

Lee,

Hsueh

2023

Current Opinion in Infectious Diseases

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Purpose of review This systematic review aimed to explore the recent trends in the epidemiology, risk factors, and antimicrobial susceptibility of two emerging opportunistic pathogens, Stenotrophomonas maltophilia and Elizabethkingia anophelis. Recent findings Since 2020, numerous outbreaks of S. maltophilia and E. anophelis have been reported worldwide. Most of these outbreaks have been associated with healthcare facilities, although one outbreak caused by E. anophelis in France was considered a community-associated infection. In terms of antimicrobial susceptibility, trimethoprim/sulfamethoxazole (TMP-SMZ), levofloxacin, and minocycline have exhibited good efficacy against S. maltophilia. Additionally, cefiderocol and a combination of aztreonam and avibactam have shown promising results in in vitro susceptibility testing. For E. anophelis, there is currently no consensus on the optimal treatment. Although some studies have reported good efficacy with rifampin, TMP-SMZ, piperacillin/tazobactam, and cefoperazone/sulbactam, minocycline had the most favourable in vitro susceptibility rates. Cefiderocol may serve as an alternative due to its low minimum inhibitory concentration (MIC) against E. anophelis. The role of vancomycin in treatment is still uncertain, although several successful cases with vancomycin treatment, even with high MIC values, have been reported. Summary Immunocompromised patients are particularly vulnerable to infections caused by S. maltophilia and E. anophelis, but the optimal treatment strategy remains inconclusive. Further research is necessary to determine the most effective use of conventional and novel antimicrobial agents in combatting these multidrug-resistant pathogens.

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Clinical and microbiological characteristics of patients colonized or infected by Stenotrophomonas maltophilia: is resistance to sulfamethoxazole/trimethoprim a problem?

Cited by 7 publications

References 17 publications

A 20-year trend of prevalence and susceptibility to trimethoprim/sulfamethoxazole of Stenotrophomonas maltophilia in a single secondary care hospital in Korea

A 20-year trend of prevalence and susceptibility to trimethoprim/sulfamethoxazole of Stenotrophomonas maltophilia in a single secondary care hospital in Korea

Stenotrophomonas maltophilia Bacteremia: From Diagnosis to Treatment

Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis

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