Resurgence of global opportunistic multidrug-resistant Stenotrophomonas maltophilia

Abstract

Context:Stenotrophomonas maltophilia is a known nosocomial pathogen which is intrinsically resistant to multiple antibiotics. In India, S. maltophilia infection has only few case reports.Aim:To determine the incidence of S. maltophilia infection from clinical isolates based on the specimen type, antibiotic susceptibility pattern, and impact on outcome.Settings and Design:One-year retrospective study was done at a tertiary liver care center.Methods:Patients with S. maltophilia isolation in clinical samples were selected. Serial levels of serum procalcitonin and total leukocyte count were recorded. Environmental surveillance was done from the wards of S. maltophilia isolation as part of routine practice.Statistical Analysis:Continuous data were compared using Kruskal–Wallis test/Mann–Whitney test. The categorical data were compared by Chi-square/Fisher's exact test, wherever necessary. Besides this, an appropriate analysis like survival was carried out at the time of data analysis.Results:One hundred isolates were obtained from eighty patients of six wards. The greatest number (44/100, 44%) were from the Liver Coma Intensive Care Unit and the lowest (3/100) from the day care. Isolation from the respiratory samples was 1.32% and bloodstream infection 0.6%. Of 100 isolates, 12 (12%) were resistant to both trimethoprim–sulfamethoxazole and levofloxacin.Conclusion:S. maltophilia was effectively isolated from the hospital environment, with two of hand impression and three of water samples’ positive. Patients with respiratory infection had most S. maltophilia isolates. Antibiotic susceptibility revealed more resistance than reported in this region.

Risk Factors and Clinical Outcomes of Stenotrophomonas maltophilia Infections: Scenario in a Tertiary Care Center from South India

“…Well-established risk factors for infection include lengthened hospitalization requiring invasive procedures, admission in an Intensive Care Unit (ICU), indwelling catheters, mechanical ventilation, recent exposure to antibiotics, corticosteroid or immunosuppressant therapy, underlying malignancy, and organ transplantation. 3 , 4 , 7 Most common risk factors contributing to S. maltophilia infection in this study were presence of comorbidities like type 2 diabetes mellitus, chronic kidney disease and malignancy, mechanical ventilation, prolonged hospital stay, recent surgery, and previous hospitalization ( Fig. 1 ).…”

Stenotrophomonas maltophilia: An uncommon cause of liver abscess

“…The organism infecting our patient in the present case was found to be resistant to ticarcillin-clavulanic acid; hence he was treated with a combination of levofloxacin and trimethoprim-sulfamethoxazole, resulting in a successful clinical outcome. However, it is to be noted that, resistance to trimethoprim-sulfamethoxazole and levofloxacin have been found in 26 % and 24 % of Indian isolates, respectively [ 20 ]. Earlier, the results from the SENTRY Antimicrobial Surveillance Program in 2004, had showed a level of resistance to trimethoprim-sulfamethoxazole of 3.8 % for S. maltophilia isolates [ 21 ].…”