Global prevalence and distribution of antibiotic resistance among clinical isolates of Stenotrophomonas maltophilia: A systematic review and meta-analysis

Dadashi, Masoud; Hajikhani, Bahareh; Nazarinejad, Nooshin; Nourisepehr, Negin; Yazdani, Shahrooz; Hashemi, Ali; Hashemizadeh, Zahra; Goudarzi, Mehdi; Sameni, Fatemeh

doi:10.1016/j.jgar.2023.02.018

Cited by 23 publications

(23 citation statements)

References 165 publications

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“…It is noteworthy that Elizabethkingia spp. and S. maltophilia , due to the intrinsic resistance, are associated with infections after prolonged carbapenem therapy [18,49 ▪▪ ].…”

Section: Text Of Reviewmentioning

confidence: 99%

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

Koulenti,

Vandana,

Rello

2023

Current Opinion in Infectious Diseases

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Purpose of review This article aims to review the epidemiology of nonfermenting Gram-negative bacilli (NFGNB) based on recent literature reports, particularly, of the less common, but with emerging clinical significance species. Recent findings The reported frequency of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa is increasing, with very significant variability, however, between different countries. Apart from the major NFGNB, that is, A. baumannii and P. aeruginosa, already recognized as of critical importance healthcare risks, several other NFGNB genera have been increasingly associated with diverse severe infections, such as Stenotrophomonas maltophilia, Burkholderia spp., Elizabethkingia spp., Chryseobacterium spp., Achromobacter spp., Alcaligenes spp., Sphingomonas spp., Shewanella spp. and Ralstonia spp., among others. Summary The exploration of the epidemiology, as well as the pathogenic potential of the of the less frequent, but emerging and increasingly reported NFGNB, is crucial, not only for immunocompromised patients, but also for critically ill patients without overt immunosuppression. As we are heading fast towards a postantibiotic era, such information would contribute to the optimal antimicrobial management, that is, providing prompt, appropriate antimicrobial coverage when needed and, at the same time, avoiding overuse and/or inappropriate use of antimicrobial therapy. Also, it would help to better understand their transmission dynamics and to develop effective prevention strategies.

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“…It is noteworthy that Elizabethkingia spp. and S. maltophilia , due to the intrinsic resistance, are associated with infections after prolonged carbapenem therapy [18,49 ▪▪ ].…”

Section: Text Of Reviewmentioning

confidence: 99%

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

Koulenti,

Vandana,

Rello

2023

Current Opinion in Infectious Diseases

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“…– which included retrospective cohort and case-control studies – demonstrated that fluoroquinolone therapy was non-inferior to SXT in SM infections (in fact, in some instances, fluoroquinolones were associated with survival benefit over SXT), further studies are needed to establish reliable evidence in this field [ 25 ]. SXT-resistance rates show considerable variation worldwide: based on a recent systematic review and meta-analysis by Dadashi et al., the highest pooled resistance rates were reported in Asia (19.29%), followed by Europe (10.52%), and the Americas (7.01%) [ 26 ]; nevertheless, individual prevalence studies from various geographical regions (e.g., Turkey: 10–15%, Spain >25%, China: 30–48%) and patient-groups (e.g., in cystic fibrosis patients: as high as 80%) may report considerably higher rates of resistance [ 27 , 28 ]. HAIs caused by SXT-resistant SM are notifiable diseases under the framework of the National Nosocomial Infections Surveillance Network in Hungary (NNSzR); according to recent reports, the incidence-density of SXT-resistant SM nationally were 0.0014/1000 patient-days and 0.002/1000 patient-days in 2019 and 2020, respectively [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Correlation between Stenotrophomonas maltophilia incidence and systemic antibiotic use: A 10-year retrospective, observational study in Hungary

Gajdács,

Matuz,

Ria

et al. 2024

EuJMI

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Extensive use of carbapenems may lead to selection pressure for Stenotrophomonas maltophilia (SM) in hospital environments. The aim of our study was to assess the possible association between systemic antibiotic use and the incidence of SM. A retrospective, observational study was carried out in a tertiary-care hospital in Hungary, between January 1st 2010 and December 31st 2019. Incidence-density for SM and SM resistant to trimethoprim-sulfamethoxazole (SXT) was standardized for 1000 patient-days, while systemic antibiotic use was expressed as defined daily doses (DDDs) per 100 patient-days. Mean incidence density for SM infections was 0.42/1000 patient-days; 11.08% were were resistant to SXT, the mean incidence density for SXT-resistant SM was 0.047/1000 patient-days. Consumption rate for colistin, glycopeptides and carbapenems increased by 258.82, 278.94 and 372.72% from 2010 to 2019, respectively. Strong and significant positive correlations were observed with the consumption of carbapenems (r: 0.8759; P < 0.001 and r: 0.8968; P < 0.001), SXT (r: 0.7552; P = 0.011 and r: 0.7004; P = 0.024), and glycopeptides (r: 0.7542; P = 0.012 and r: 0.8138; P < 0.001) with SM and SXT-resistant SM incidence-density/1000 patient-days, respectively. Implementation of institutional carbapenem-sparing strategies are critical in preserving these life-saving drugs, and may affect the microbial spectrum of infections in clinical settings.

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“…Levofloxacin (LVX) was the second most common therapeutic choice in clinical practice among papers reviewed (Table 2). Compared to SXT, LVX susceptibility rates are lower worldwide (global average is 81%; 88% in Latin America; 83% in Europe; 80% in Asia-Pacific; and 78% in North America) [17,31 ▪ ,96,97 ▪ ]. Moreover, LVX has a higher rate of resistance emergence than SXT (20% vs. 8%, respectively) [9,17,98,99].…”

Section: Introductionmentioning

confidence: 99%

“…Herein, we summarize antibiotic resistance mechanisms and discuss the therapeutic options currently available to treat Sma infections. For an in-depth review on the epidemiology, genetics and antimicrobial susceptibility testing of Sma , the reader is directed to the following reviews [30,31 ▪ ,32,33 ▪▪ ,34 ▪ ]…”

Section: Introductionmentioning

confidence: 99%

“…SXT is the first-line treatment for Sma infections, and the preferred treatment option in papers published after January 2022 (Table 2). Average susceptibility rates for this agent varies among geographical regions, being the highest in Europe (>95%), followed by the Middle East (≈93%), USA (≈90%), Latin America (≈80%), and the lowest in Asia (<80% in China; 87% in Korea) [17,31 ▪ ,34 ▪ ,42,83 ▪▪ ,84 ▪ –88 ▪ ]. SXT lacks established PK/PD index or target threshold for efficacy or toxicity, which severely impairs the ability to optimize its clinical use [34 ▪ ,89 ▪ ,90 ▪▪ ,91 ▪▪ ,92].…”

Section: Introductionmentioning

confidence: 99%

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Treatment approaches for severe Stenotrophomonas maltophilia infections

Mojica,

Bonomo,

van Duin

2023

Current Opinion in Infectious Diseases

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Purpose of review Stenotrophomonas maltophilia is an emerged opportunistic pathogen. Intrinsic multidrug resistance makes treating infections caused by S. maltophilia a great clinical challenge. Herein, we provide an update on the most recent literature on treatment options for severe S. maltophilia infections. Recent findings Trimethoprim-sulfamethoxazole (SXT) is recognized as the first-line therapy for S. maltophilia infections. However, its clinical use is based on good in vitro activity and favorable clinical outcomes, rather than on solid minimum inhibitory concentration (MIC) correlations with pharmacokinetic/pharmacodynamics (PK/PD) and/or clinical outcomes. The same is true for other treatment options like levofloxacin (LVX) and minocycline (MIN). Recent PK/PD studies question the current clinical breakpoints for SXT, LVX, and MIN. Based on this, the latest guidance issued by the Infectious Diseases Society of America (IDSA) recommends using these agents only as part of a combination therapy. Alternatively, novel therapeutic options such as cefiderocol (FDC) and ceftazidime-avibactam plus aztreonam (CZA-ATM) are suggested, based on limited but promising clinical data. Summary PK/PD data and controlled clinical studies are needed to optimize current treatment options. Presently, combination therapy of SXT, LVX, MIN, or FDC, or monotherapy with CZA-ATM are recommended therapeutic options for severe-to-moderate S. maltophilia infections.

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Global prevalence and distribution of antibiotic resistance among clinical isolates of Stenotrophomonas maltophilia: A systematic review and meta-analysis

Cited by 23 publications

References 165 publications

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

Correlation between Stenotrophomonas maltophilia incidence and systemic antibiotic use: A 10-year retrospective, observational study in Hungary

Treatment approaches for severe Stenotrophomonas maltophilia infections

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