Stenotrophomonas Bacteremia Antibiotic Susceptibility and Prognostic Determinants: Mayo Clinic 10-Year Experience

Abstract

Background Stenotrophomonas maltophilia is a gram-negative, opportunistic infection that is usually hospital-acquired and associated with high morbidity and mortality. The reported increase in S. maltophilia infections is presumed to be due to an increase in the population at risk. Methods We retrospectively reviewed 10-year data for S. maltophilia bacteremia in hospitalized adults at our institution to determine the population at risk, sources of infection, common complications, antimicrobial susceptibility profiles, and clinical outcome trends over the past decade. Results Among the 98 patients analyzed, the most common source of infection was catheter-related (62, 63.3%). Most isolates (61, 65%) were resistant to ceftazidime; fewer were resistant to trimethoprim-sulfamethoxazole (TMP-SMX; 2, 2.1%) and levofloxacin (22, 23.4%). All-cause in-hospital mortality was 29.6% (29 patients). The highest mortality, 53.8%, was observed in pulmonary sources of bacteremia. Conclusions Although TMP-SMX continues to have reliable activity in our cohort, we noted resistance to TMP-SMX in patients with recent TMP-SMX exposure, including a case with developing resistance to TMP-SMX while on therapy.

Antimicrobial Treatment Strategies for Stenotrophomonas maltophilia: A Focus on Novel Therapies

“…Susceptibility testing is hampered by Stenotrophomonas' multifaceted mechanisms of resistance to the drug; resistance mechanisms are frequently adaptive, sometimes harbored by heterogeneous subpopulations, and may only emerge upon drug exposure [35]. Rates of in vitro susceptibility range from 9 to 86% and typically require high concentrations to achieve growth inhibition [11,36,37]. Colistin in combination with other agents is frequently of interest in an effort to address multiple resistance mechanisms [34,38].…”

Infeksi dan Pola Kepekaan Stenotrophomonas maltophilia di ICU RS X

“…9,17,20,21 Bakteremia oleh S. maltophilia dengan paru sebagai fokus infeksi memberikan prognosis yang buruk. 22 Salah satu faktor lain yang meningkatkan mortalitas sesuai studi Eun Jim Kim dkk. (2019) adalah resistensi S. maltophilia terhadap antibiotik quinolone.…”

“…(2020), dengan angka kepekaan cotrimoxazole 97%, lebih tinggi dibandingkan levofloxacin 75,5%. 22 Didapatkan persentase kepekaan yang serupa untuk levofloxacin di Hungaria, Eropa, oleh Jihasz dkk. (2014) pada pasien yang terbukti infeksi yaitu 74%, sedangkan pada kasus kolonisasi, kepekaan levofloxacin mencapai 84%.…”

Antimicrobial Resistance in Clinical Strains of Stenotrophomonas maltophilia: 10-year surveillance

“…Stenotrophomonas maltophilia günümüzde gittikçe daha sık izole edilen, fırsatçı bir nozokomiyal enfeksiyon etkenidir (21) . Son yıllarda geniş spektrumlu antibiyotiklerin yaygın kullanımı, invaziv girişimler ve bağışıklık sistemi baskılanmış hasta sayısındaki artış nedeniyle giderek artan sıklıkta izole edilmektedir (12) . S. maltophilia'nın sebep olduğu nozokomiyal enfeksiyonlar; çoğunlukla akciğer enfeksiyonu, üriner sistem enfeksiyonu, kateter ilişkili enfeksiyon, bakteriyemi ve sepsis olarak tanımlanmaktadır (18) .…”