Community acquired Stenotrophomonas maltophilia discitis: Diagnosis aided by shotgun metagenomic sequencing

Wang, Gang; Xu, Nannan; Zheng, Feng; Sai, Lintao; Zhou, Jiale; Yang, Shangxin

doi:10.1016/j.ijid.2019.01.032

Cited by 14 publications

(5 citation statements)

References 14 publications

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“…Eight patients had undergone wet cupping and two patients had dry cupping. Wang et al have reported a case of a 12-year-old patient who suffered from an epidural abscess due to Stenotrophomonas maltophilia infection after a session of dry cupping at the lower back [ 8 ]. Multiple microorganisms were detected, including Staphylococcus aureus, Pseudomonas spp., Mycobacterium massiliense, and herpes simplex virus [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Disseminated Staphylococcus aureus Infection in an Adolescent Patient Following a Traditional Phlebotomy Procedure

Oon,

Abdul Razak,

Awang

2023

Cureus

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Al-Fashdu is a well-known Islamic medicine-based alternative treatment, and it has been widely practiced with the aim of treating certain health issues in various countries. Unfortunately, this therapy can lead to certain complications, including life-threatening infections. We report a case of a 12-year-old male patient who developed a disseminated Staphylococcus aureus infection following Al-Fashdu therapy. He was treated with surgical drainage and intravenous antibiotics. To our knowledge, this is the first report of a disseminated Staphylococcus aureus infection following Al-Fashdu therapy in an adolescent patient.

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Section: Discussionmentioning

confidence: 99%

Disseminated Staphylococcus aureus Infection in an Adolescent Patient Following a Traditional Phlebotomy Procedure

Oon,

Abdul Razak,

Awang

2023

Cureus

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“…We searched the PubMed database using "Stenotrophomonas maltophilia, children, community acquired" as the keywords, and found only seven case reports of community-acquired infection in children in the past decade (2012-2022). [6][7][8][9] These seven patients developed meningitis, bacteremia, intervertebral discitis, etc, which was successfully treated with antibiotics (TMP/SMX, levofloxacin, etc.) despite their major side effects (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Community-Acquired Stenotrophomonas Maltophilia Infection in a Child: A Case Report and Literature Review

Jiang¹,

Ren²,

Zhang³

et al. 2022

IDR

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Background: Stenotrophomonas maltophilia (S. maltophilia) is a pathogen causing opportunistic and nosocomial infections that are invasive and fatal, especially in hospitalized and immunocompromised patients. However, community-acquired S. maltophilia is rarely reported in children with normal immunity. S. maltophilia is a multi-drug-resistant bacterium, and the preferred drug is trimethoprim/ sulfamethoxazole (TMP/SMX), which has greater side effects in children. Case Presentation: Herein, we reported the case of a child with clinical manifestations of fever, high C-reactive protein (CRP) and white blood cells, and severe pneumonia. The blood culture yielded S. maltophilia. The initial treatment regimen was meropenem IV, which was subsequently changed to ceftazidime IV, and finally to oral cefixime, which has less side effects in children. The child recovered completely. At the 1-month follow-up, anteroposterior chest X-ray was normal, and the child was in good general health. Conclusion:Although community-acquired S. maltophilia infection in children is rare, it can occur. The doctor encountered such a child in clinical work. This child has a normal immune system, his disease comes from a community infection and has lobar pneumonia located in the lower lung area. At the same time, the child's white blood cells and CRP values are high, the doctor should be concerned that the child may have S. maltophilia infection. When treating patients, doctors can try to use drugs empirically, such as ceftazidime, instead of using ciprofloxacin, SMZ and other drugs that have relatively large side effects in children. It is worth mentioning that doctors also need to adjust the medication in a timely manner according to the efficacy evaluation and drug sensitivity of the children after the medication, so as to minimize the drug resistance of community-acquired infections. This will prevent the misuse of Meropenem, which has been given in a community patient and that too in a child. Its important to prevent this malpractise.

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“…Results were analysed using the double-delta Ct method, normalizing gene expression of sme gene transcripts against gyrA expression. Primer sequences for smeT , 15 smeD , 16 smeE 17 and gyrA 17 are published elsewhere.…”

Section: Methodsmentioning

confidence: 99%

Evolution of cefiderocol resistance in Stenotrophomonas maltophilia using in vitro serial passage techniques

Werth

Ashford

Penewit

et al. 2022

JAC-Antimicrobial Resistance

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Objectives Cefiderocol is a siderophore cephalosporin active against MDR Gram-negatives including Stenotrophomonas maltophilia. Cefiderocol resistance remains uncommon and incompletely understood. We selected for cefiderocol-resistant S. maltophilia in vitro and characterized the genetic mechanisms and potential for cross-resistance to other antimicrobials. Methods We selected cefiderocol resistance in three clinical strains of S. maltophilia by serial passage in escalating concentrations of cefiderocol. Emergent cefiderocol-resistant isolates were subjected to repeat susceptibility testing against a panel of relevant antimicrobials. Isolates with confirmed MIC changes were whole genome sequenced. Results Each parent strain was initially susceptible to cefiderocol (MICs of 0.03125, 0.03125 and 0.125 mg/L), and one initially tested susceptible to ceftazidime/avibactam (MIC 4 mg/L). We recovered evolved isolates achieving cefiderocol resistance at MICs of 8–32 mg/L from each parental strain. Some cefiderocol resistant isolates reverted following one to four drug-free passages. Ceftazidime/avibactam MICs of passaged isolates repeatedly increased to ≥256 mg/L, and while other MICs were largely unchanged, trimethoprim/sulfamethoxazole MICs declined 4-fold in two strains. WGS revealed one evolved isolate carrying six coding mutations, while four were isogenic mutants of tonB, tolQ, smf-1 and the smeT promoter. Mutation of the smeT promoter downregulated the smeDEF efflux pump and reduced susceptibility to penicillins but increased susceptibility to several other classes including sulphonamides. Other mutations occurred in genes putatively involved in iron metabolism including smlt1148 and cirA. Conclusions S. maltophilia strains evolved cefiderocol resistance through different genetic pathways, but often involved iron transport. Future work is required to fully understand the role(s) of other genes in cefiderocol resistance.

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Community acquired Stenotrophomonas maltophilia discitis: Diagnosis aided by shotgun metagenomic sequencing

Cited by 14 publications

References 14 publications

Disseminated Staphylococcus aureus Infection in an Adolescent Patient Following a Traditional Phlebotomy Procedure

Disseminated Staphylococcus aureus Infection in an Adolescent Patient Following a Traditional Phlebotomy Procedure

Community-Acquired Stenotrophomonas Maltophilia Infection in a Child: A Case Report and Literature Review

Evolution of cefiderocol resistance in Stenotrophomonas maltophilia using in vitro serial passage techniques

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