Stenotrophomonas maltophilia: More than Just a Colonizer!

Baidya, Ankita; Kodan, Parul; Fazal, Farhan; Tsering, Sandgup; Menon, P. Ramesh; Jorwal, Pankaj; Chowdhury, Ujjwal K.

doi:10.5005/jp-journals-10071-23241

Cited by 14 publications

(8 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Guidance on the dosing and monitoring requirements of TMP-SMX for the treatment of S. maltophilia infection in preterm neonates is limited to case reports. TMP-SMX dosing for S. maltophilia pneumonia varies from 3 to 6 mg/kg/d (of TMP), either as monotherapy 11 or with colistin 12 or levofloxacin. 13 TMP-SMX dosing at 5 mg/kg/d (of TMP) in conjunction with ciprofloxacin has been used successfully to treat extra-ventricular drain related meningitis.…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Cefiderocol to Treat a Multidrug-resistant Stenotrophomonas maltophilia Ventilator-associated Pneumonia in an Extremely Preterm Neonate

Koirala,

Krishnappa,

Banh

et al. 2023

Pediatric Infectious Disease Journal

View full text Add to dashboard Cite

Background: Ventilator-associated pneumonia (VAP) caries a morbidity and mortality risk in the preterm neonate, particularly in the context of rising global antimicrobial resistance driving infections due to multidrug-resistant Gram-negative bacteria. Cefiderocol, a siderophilic cephalosporin, has broad Gram-negative antimicrobial activity and central nervous system penetration and is used for the treatment of hospital-acquired pneumonia or VAP in adults. Scarce data exists on its use in neonates. Case: A female neonate born at 26 + 6 weeks developed VAP at 21 days of life. She was commenced on corticosteroids, vancomycin and ceftazidime but continued to deteriorate. Sputum cultures yielded Stenotrophomonas maltophilia resistant to trimethoprim/sulfamethoxazole, ciprofloxacin and ceftazidime, with potential susceptibility to cefiderocol. Cerebrospinal fluid showed an elevated white cell count. In view of worsening respiratory and hemodynamic status, antibiotic treatment was changed to cefiderocol monotherapy at 30 mg/kg/dose every 8 hours. Within 72 hours of commencing cefiderocol, the neonate was successfully extubated to variable-flow continuous positive airway pressure and showed ongoing clinical improvement. Conclusions: Cefiderocol was integral for the care of our neonate without any immediate adverse safety consequences. We relied on dosing data from a conference abstract, due to the paucity of evidence on the use of novel antimicrobials. This lack of evidence is particularly concerning given preterm neonates are particularly vulnerable to infections with multidrug-resistant Gram-negative organisms due to their immature immune systems, prolonged hospital stay, repeated interventions and antimicrobial exposure.

show abstract

Section: Discussionmentioning

confidence: 99%

Successful Use of Cefiderocol to Treat a Multidrug-resistant Stenotrophomonas maltophilia Ventilator-associated Pneumonia in an Extremely Preterm Neonate

Koirala,

Krishnappa,

Banh

et al. 2023

Pediatric Infectious Disease Journal

View full text Add to dashboard Cite

show abstract

“…is a cause of true infection [2,30,60]. Nonetheless, Sma has been increasingly recognized as a true opportunistic pathogen that causes considerable morbidity and mortality in vulnerable populations [5,6,23,[61][62][63][64][65][66][67]. In a retrospective cohort study conducted in China, the prognosis of patients with hospital-acquired pneumonia (HAP) by Sma and K. pneumoniae were compared.…”

Section: Key Pointsmentioning

confidence: 99%

Treatment approaches for severe Stenotrophomonas maltophilia infections

Mojica,

Bonomo,

van Duin

2023

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

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.

show abstract

“…The differentiation between S. maltophilia infections and colonisation remains challenging, particularly in patients with ventilator devices (1,9). Over the past years, researchers have assessed S. maltophilia infections in ICUs, including bloodstream infections, skin and soft tissues infections, urinary tract infections and ventilator-associated pneumonia (VAP), reporting high mortality rates (5,10).…”

Section: Introductionmentioning

confidence: 99%

Management of ventilator‑associated pneumonia due to Stenotrophomonas maltophilia infection: A case report and literature review

et al. 2023

View full text Add to dashboard Cite

Stenotrophomonas maltophilia (S. maltophilia) is a difficult-to-treat bacteria. This glucose non-fermenting, multidrug-resistant Gram-negative bacillus is known to cause a range of infections, such as skin manifestations and bacteraemia, with respiratory tract infections being the most common. Patients in intensive care units are often exposed to a higher risk of acquiring an infection caused by this pathogen. Although distinguishing between S. maltophilia infections and colonization can be challenging, pneumonia caused by S. maltophilia infection is becoming increasingly prevalent. Furthermore, S. maltophilia infections are often coupled with Pseudomonas aeruginosa infections, reinforcing the need to consider this bacterium as a potential cause of ventilator-associated pneumonia (VAP). The present study describes the case of a 66-year-old male who was diagnosed with VAP due to S. maltophilia infection. This condition was effectively treated with trimethoprim/sulfamethoxazole. The case described herein underscores the importance of prompt recognition through heightened clinical suspicion, particularly in patients with VAP who are unresponsive to broad-spectrum β-lactam antibiotics. The early identification of S. maltophilia as the root cause of respiratory tract infections can make a significant difference to the outcomes of affected patients.

show abstract

Stenotrophomonas maltophilia: More than Just a Colonizer!

Cited by 14 publications

References 8 publications

Successful Use of Cefiderocol to Treat a Multidrug-resistant Stenotrophomonas maltophilia Ventilator-associated Pneumonia in an Extremely Preterm Neonate

Successful Use of Cefiderocol to Treat a Multidrug-resistant Stenotrophomonas maltophilia Ventilator-associated Pneumonia in an Extremely Preterm Neonate

Treatment approaches for severe Stenotrophomonas maltophilia infections

Management of ventilator‑associated pneumonia due to Stenotrophomonas maltophilia infection: A case report and literature review

Contact Info

Product

Resources

About