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Semin Respir Crit Care Med 2007; 28(6): 672-677
DOI: 10.1055/s-2007-996414
Published by Thieme Medical Publishers

Optimizing Therapy for Stenotrophomonas maltophilia

Robert R. Muder1 , 2
  • 1Infectious Disease Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
  • 2Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Further Information

Publication History

Publication Date:
20 December 2007 (online)

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ABSTRACT

Stenotrophomonas (Xanthomonas) maltophilia is a nonfermentative, gram-negative bacillus that is widely distributed in natural and humanmade environments. In the nonhospital setting it is an uncommon pathogen, typically causing soft tissue infection of contaminated wounds. In the hospital setting, particularly among critical care and oncology patients, S. maltophilia may cause catheter-related bacteremia, pneumonia, soft tissue infection, meningitis, prosthetic valve endocarditis, and ocular infections. S. maltophilia is usually resistant to multiple antimicrobials, including expanded-spectrum penicillins, third-generation cephalosporins, carbapenems, aminoglycosides, and quinolones. Trimethoprim-sulfamethoxazole is the antimicrobial agent of choice for this pathogen but is bacteriostatic. Further, resistance to this agent is increasing. Certain combinations of antibiotics are synergistic and may be appropriate for patients harboring resistant organisms or with life-threatening infections.

KEYWORDS

Stenotrophomonas (Xanthomonas) maltophilia - nosocomial infections - antimicrobial resistance

REFERENCES

  • 1 Denton M, Kerr K G. Microbiologic and clinical aspects of infection associated with Stenotrophomonas maltophilia. .  Clin Microbiol Rev. 1998;  11 57-80
    CrossrefPubMedGoogle Scholar
  • 2 Agger W A, Cogbill T H, Busch H, Landercasper J, Callister S M. Wounds caused by corn-harvesting machines: an unusual source of infection due to gram-negative bacilli.  Rev Infect Dis. 1986;  8 927-931
    PubMedGoogle Scholar
  • 3 Daley A J, McIntyre P B. Stenotrophomonas maltophilia and lawn mower injuries in children.  J Trauma. 2000;  48 536-539
    PubMedGoogle Scholar
  • 4 Heath T, Currie B. Nosocomial and community-acquired Xanthomonas maltophilia infection in tropical Australia.  J Hosp Infect. 1995;  30 309-313
    CrossrefPubMedGoogle Scholar
  • 5 Elting L S, Bodey G P. Septicemia due to Xanthomonas species and non-aeruginosa Pseudomonas species: increasing incidence of catheter related infections.  Medicine. 1990;  69 296-306
    PubMedGoogle Scholar
  • 6 Khardori N, Elting L, Wong E, Schable B, Bodey G P. Nosocomial infections due to Xanthomonas maltophilia (Pseudomonas maltophilia) in patients with cancer.  Rev Infect Dis. 1990;  12 997-1003
    PubMedGoogle Scholar
  • 7 Muder R R, Harris A P, Muller S et al.. Bacteremia due to Stenotrophomonas maltophilia: a prospective, multicenter study of 91 episodes.  Clin Infect Dis. 1996;  22 508-512
    PubMedGoogle Scholar
  • 8 Lai C-H, Chi C-Y, Chen H-P et al.. Clinical characteristics and prognostic factors of patients with Stenotrophomonas maltophilia bacteremia.  J Microbiol Immunol Infect. 2004;  37 350-358
    PubMedGoogle Scholar
  • 9 Wang W-S, Liu C-P, Lee C-M, Huang F-Y. Stenotrophomonas maltophilia bacteremia in adults: four years' experience in a medical center in northern Taiwan.  J Microbiol Immunol Infect. 2004;  37 359-365
    PubMedGoogle Scholar
  • 10 Vartivarian S E, Papadakis K A, Palacios J A, Manning J T, Anaissie E J. Mucocutaneous and soft tissue infections caused by Xanthomonas maltophilia: a new spectrum.  Ann Intern Med. 1994;  121 969-973
    PubMedGoogle Scholar
  • 11 Papadakis K A, Varivarian S E, Vassilaki M E, Anaissie E J. Stenotrophomonas maltophilia meningitis: report of two cases and review of the literature.  J Neurosurg. 1997;  87 106-108
    PubMedGoogle Scholar
  • 12 Mehta N J, Khan I A, Mehta R N, Gulati A. Stenotrophomonas maltophilia endocarditis of prosthetic aortic valve: report of a case and review of literature.  Heart Lung. 2000;  29 351-355
    CrossrefPubMedGoogle Scholar
  • 13 Penland R L, Wilhelmus K R. Stenotrophomonas maltophilia ocular infections.  Arch Ophthalmol. 1996;  114 433-436
    PubMedGoogle Scholar
  • 14 McGowen J E. Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum.  Am J Med. 2006;  119 S29-S36
    PubMedGoogle Scholar
  • 15 Weber D J, Rutala W A, Blanchet C N, Jordan M, Gergen M F. Faucet aerators: a source of patient colonization with Stenotrophomonas maltophilia .  Am J Infect Control. 1999;  27 59-63
    PubMedGoogle Scholar
  • 16 Verweij P E, Meis J F, Christmann V et al.. Nosocomial outbreak of colonization and infection with Stenotrophomonas maltophilia in preterm infants associated with contaminated tap water.  Epidemiol Infect. 1998;  120 251-256
    CrossrefPubMedGoogle Scholar
  • 17 Denton M, Rajgopal A, Mooney L et al.. Stenotrophomonas maltophilia contamination of nebulizers used to deliver aerosolized therapy to inpatients with cystic fibrosis.  J Hosp Infect. 2003;  55 180-183
    CrossrefPubMedGoogle Scholar
  • 18 Lanotte P, Cantagrel S, Mereghetti L et al.. Spread of Stenotrophomonas maltophilia colonization in a pediatric intensive care unit detected by monitoring tracheal bacterial carriage and molecular typing.  Clin Microbiol Infect. 2003;  9 1142-1147
    CrossrefPubMedGoogle Scholar
  • 19 Marshall W F, Keating M R, Anhalt J P, Steckelberg J M. Xanthomonas maltophilia: an emerging nosocomial pathogen.  Mayo Clin Proc. 1989;  64 1097-1104
    PubMedGoogle Scholar
  • 20 Victor M A, Arpi M, Bruun B, Jonsson V, Hansen M M. Xanthomonas maltophilia bacteremia in immunocompromised hematological patients.  Scand J Infect Dis. 1994;  26 163-170
    PubMedGoogle Scholar
  • 21 Tsai W P, Chen C L, Ko W C, Pan S C. Stenotrophomonas maltophilia bacteremia in burn patients.  Burns. 2006;  32 155-158
    CrossrefPubMedGoogle Scholar
  • 22 Figueiredo P M, Furumura M T, Santos A M et al.. Cytotoxic activity of Stenotrophomonas maltophilia .  Lett Appl Microbiol. 2006;  43 443-449
    CrossrefPubMedGoogle Scholar
  • 23 Waters V J, Gomz M I, Soong G, Amin S, Ernst R K, Prince A. Immunostimulatory properties of the emerging pathogen Stenotrophomonas maltophilia .  Infect Immun. 2007;  75 1698-1703
    CrossrefPubMedGoogle Scholar
  • 24 Micozzi A, Venditti M, Monaco M et al.. Bacteremia due to Stenotrophomonas maltophilia in patients with hematologic malignancies.  Clin Infect Dis. 2000;  31 705-711
    CrossrefPubMedGoogle Scholar
  • 25 Sattler C A, Mason E O, Kaplan S L. Nonrespiratory Stenotrophomonas maltophilia infection at a children's hospital.  Clin Infect Dis. 2000;  31 1321-1330
    CrossrefPubMedGoogle Scholar
  • 26 Boktour M, Hanna H, Ansari S et al.. Central venous catheter and Stenotrophomonas maltophilia bacteremia in cancer patients.  Cancer. 2006;  106 1967-1973
    CrossrefPubMedGoogle Scholar
  • 27 Wu P S, Lu C Y, Chang L Y et al.. Stenotrophomonas maltophilia bacteremia in pediatric patients: a 10 year analysis.  J Microbiol Immunol Infect. 2006;  39 144-149
    PubMedGoogle Scholar
  • 28 Pathmanathan A, Waterer A. Significance of positive Stenotrophomonas maltophilia culture in acute respiratory tract infection.  Eur Respir J. 2005;  25 911-914
    CrossrefPubMedGoogle Scholar
  • 29 Elsner H A, Duhrsen U, Hollwitz B, Kaulfers P M, Hossfeld D K. Fatal pulmonary hemorrhage in patients with acute leukemia and fulminant pneumonia caused by Stenotrophomonas maltophilia .  Ann Hematol. 1997;  74 155-161
    PubMedGoogle Scholar
  • 30 Burns J L, Emerson J, Stapp J R et al.. Microbiology of sputum from patients at cystic fibrosis centers in the United States.  Clin Infect Dis. 1998;  27 158-163
    CrossrefPubMedGoogle Scholar
  • 31 Marchac V, Equil A, Le Behan-Benjamin C, Hodson M, Bush A. Case control study of Stenotrophomonas maltophilia acquisition in cystic fibrosis patients.  Eur Respir J. 2004;  23 98-102
    CrossrefPubMedGoogle Scholar
  • 32 Downhour N P, Petersen E A, Krueger T S, Tangella K V, Nix D E. Severe cellulitis/myositis caused by Stenotrophomonas maltophilia .  Ann Pharmacother. 2002;  36 63-66
    PubMedGoogle Scholar
  • 33 Aydin K, Koksol I, Kaygusuz S, Kaklikkaya I, Caylan R, Ozdemir R. Endocarditis caused by Stenotrophomonas maltophilia .  Scand J Infect Dis. 2000;  32 427-430
    PubMedGoogle Scholar
  • 34 Gutierrez Rodero F, del Mar Masia M, Cortes J, Ortiz de la Tabla V, Mainar V, Vilar A. Endocarditis caused by Stenotrophomonas maltophilia: case report and review.  Clin Infect Dis. 1996;  23 1261-1265
    PubMedGoogle Scholar
  • 35 Al-Hilali N, Nampoory M R, Johny K V, Chugh T D. Xanthomonas maltophilia infection in chronic peritoneal dialysis.  Scand J Urol Nephrol. 2000;  34 67-69
    PubMedGoogle Scholar
  • 36 Szeto C C, Li P K, Leung C B, Yu A W, Lui S F, Lai K N. Xanthomonas maltophilia peritonitis in uremic patients receiving continuous ambulatory peritoneal dialysis.  Am J Kidney Dis. 1997;  29 91-95
    PubMedGoogle Scholar
  • 37 Saino Y, Kobayashi M, Inoue M, Mitsuhashi S. Purification and properties of inducible penicillin β-lactamase isolated from Pseudomonas maltophilia .  Antimicrob Agents Chemother. 1982;  22 564-570
    PubMedGoogle Scholar
  • 38 Saino Y, Inoue M, Mitsuhashi S. Purification of an inducible cephalosporinase from Pseudomonas maltophilia GN12873.  Antimicrob Agents Chemother. 1984;  25 362-365
    PubMedGoogle Scholar
  • 39 Avison M B, von Heldreich C J, Higgins C S, Bennett P M, Walsh T RA. TEM-2 β-lactamase encoded on an active TN1-like transposon in the genome of a clinical isolate of Stenotrophomonas maltophilia .  J Antimicrob Chemother. 2000;  46 879-884
    CrossrefPubMedGoogle Scholar
  • 40 al Naiemi N, Duim B, Bart A A. CTX-M extended-spectrum beta-lactamase in Pseudomonas aeruginosa and Stenotrophomonas maltophilia .  J Med Microbiol. 2006;  55 1607-1608
    PubMedGoogle Scholar
  • 41 Chang L L, Chen H F, Chang C Y, Lee T M, Wu W J. Contribution of integrons, and SmeABC and SmeDEF efflux pumps to multidrug resistance in clinical isolates of Stenotrophomonas maltophilia .  J Antimicrob Chemother. 2004;  53 518-521
    CrossrefPubMedGoogle Scholar
  • 42 Pankuch G A, Jacobs M R, Rittenhouse S F, Appelbaum P C. Susceptibilities of 123 strains of Xanthomonas maltophilia to eight β-lactams (including β-lactam-β-lactamase inhibitor combinations) and ciprofloxacin tested by five methods.  Antimicrob Agents Chemother. 1994;  38 2317-2322
    PubMedGoogle Scholar
  • 43 Fass R J, Barnishan J, Solomon M C, Ayers L W. In vitro activities of quinolones, β-lactams, tobramycin, and trimethoprim-sulfamethoxazole against non-fermentative gram-negative bacilli.  Antimicrob Agents Chemother. 1996;  40 1412-1418
    PubMedGoogle Scholar
  • 44 Valdezate S, Vindel A, Loza E, Baquero F, Canton R. Antimicrobial susceptibilities of unique Stenotrophomonas maltophilia clinical strains.  Antimicrob Agents Chemother. 2001;  45 1581-1584
    CrossrefPubMedGoogle Scholar
  • 45 Betriu C, Sanchez A, Palau M L, Gomez M, Picazo J J. Antibiotic resistance surveillance of Stenotrophomonas maltophilia, 1993-1999.  J Antimicrob Chemother. 2001;  48 152-154
    CrossrefPubMedGoogle Scholar
  • 46 Gales A C, Jones R N, Foward K R, Linares J, Sader H S, Verhoef J. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: geographic patterns, epidemiologic features, and trends in the SENTRY antimicrobial surveillance program (1997-1999).  Clin Infect Dis. 2001;  32(Suppl 2) S104-113
    CrossrefPubMedGoogle Scholar
  • 47 Vartivarian S, Anaissie E, Bodey G, Sprigg H, Rolston K. A changing pattern of susceptibility of Xanthomonas maltophilia to antimicrobial agents: implications for therapy.  Antimicrob Agents Chemother. 1994;  38 624-627
    PubMedGoogle Scholar
  • 48 San Gabriel P, Zhou J, Tabibi S, Chen T, Trauzzi M, Saiman L. Antimicrobial susceptibility and synergy studies of Stenotrophomonas maltophilia isolates from patients with cystic fibrosis.  Antimicrob Agents Chemother. 2004;  48 168-171
    CrossrefPubMedGoogle Scholar
  • 49 Toleman M A, Bennett P M, Bennett D M, Jones R N, Walsh T R. Global emergence of trimethoprim/sulfamethoxazole resistance in Stenotrophomonas maltophilia mediated by acquisition of sul genes.  Emerg Infect Dis. 2007;  13 559-565
    PubMedGoogle Scholar
  • 50 Weiss K, Restieri C, De Carolis E, Laverdiere M, Guay H. Comparative activity of new quinolones against 326 clinical isolates of Stenotrophomonas maltophilia .  J Antimicrob Chemother. 2000;  45 363-365
    PubMedGoogle Scholar
  • 51 Rolston K VI, Kontoyiannis D P, Yadegarynia D, Raad I I. Non-fermentative gram-negative bacilli in cancer patients: increasing frequency of infection and antimicrobial susceptibility of clinical isolates to fluoroquinolones.  Diagn Microbiol Infect Dis. 2005;  51 215-218
    CrossrefPubMedGoogle Scholar
  • 52 Lecso-Bornet M, Pierre J, Sarkis-Karam D, Lubera S, Bergogne-Berezin E. Susceptibility of Xanthomonas maltophilia to six quinolones and study of outer membrane proteins in resistant mutants selected in vitro.  Antimicrob Agents Chemother. 1992;  36 669-671
    PubMedGoogle Scholar
  • 53 Cheng A F, Li M K, Ling T K, French G L. Emergence of ofloxacin-resistant Citrobacter freundii and Pseudomonas maltophilia after ofloxacin therapy.  J Antimicrob Chemother. 1987;  20 283-285
    PubMedGoogle Scholar
  • 54 Insa R, Cercenado E, Goyanes M J, Morente A, Bouza E. In vitro activity of tigecycline against clinical isolates of Acinetobacter baumannii and Stenotrophomonas maltophilia. .  J Antimicrob Chemother. 2007;  59 583-585
    CrossrefPubMedGoogle Scholar
  • 55 Zelenitsky S A, Iacovides H, Ariano R E, Harding G KM. Antibiotic combinations significantly more active than monotherapy in an in vitro infection model of Stenotrophomonas maltophilia .  Diagn Microbiol Infect Dis. 2005;  51 39-43
    CrossrefPubMedGoogle Scholar
  • 56 Poulos C D, Matsumura S O, Willey B M, Low D E, McGeer A. In vitro activities of antimicrobial combinations against Stenotrophomonas (Xanthomonas) maltophilia .  Antimicrob Agents Chemother. 1995;  39 2220-2223
    PubMedGoogle Scholar
  • 57 Krueger T S, Clark E A, Nix D E. In vitro susceptibility of Stenotrophomonas maltophilia to various antimicrobial combinations.  Diagn Microbiol Infect Dis. 2001;  41 71-78
    CrossrefPubMedGoogle Scholar
  • 58 Felegie T P, Yu V L, Rumans L W, Yee R B. Susceptibility of Pseudomonas maltophilia to antimicrobial agents, singly and in combination.  Antimicrob Agents Chemother. 1979;  16 833-837
    PubMedGoogle Scholar
  • 59 Nguyen M H, Muder R R. Xanthomonas maltophilia meningitis: case report and review of the literature.  Clin Infect Dis. 1994;  19 325-326
    PubMedGoogle Scholar
  • 60 Papadakis K A, Varivarian S E, Vassilaki M E, Anaissie E J. Stenotrophomonas maltophilia meningitis: report of two cases and review of the literature.  J Neurosurg. 1997;  87 106-108
    PubMedGoogle Scholar
  • 61 Girijaratnakumari T, Raja A, Ramani R, Antony B, Shivananda P G. Meningitis due to Xanthomonas maltophilia .  J Postgrad Med. 1993;  39 153-155
    PubMedGoogle Scholar
  • 62 Muder R R, Yu V L, Dummer J S, Vinson C, Lumish R M. Infections caused by Pseudomonas maltophilia: expanding clinical spectrum.  Arch Intern Med. 1987;  147 1672-1674
    CrossrefPubMedGoogle Scholar
  • 63 Chen S, Stroh E M, Wald K, Jalkh A. Xanthomonas maltophilia endophthalmitis after implantation of sustained-release ganciclovir.  Am J Ophthalmol. 1992;  114 772-773
    PubMedGoogle Scholar
  • 64 Kaiser G M, Tso P C, Morris R, McCurdy D. Xanthomonas maltophilia endophthalmitis after cataract extraction.  Am J Ophthalmol. 1997;  123 410-411
    PubMedGoogle Scholar
  • 65 Karakurt A, Abdik O, Sengun A et al.. Stenotrophomonas maltophilia endophthalmitis after cataract extraction.  Ocul Immunol Inflamm. 2006;  14 41-46
    PubMedGoogle Scholar

Robert R MuderM.D. 

Infectious Disease Section 111E-U, VA Pittsburgh Healthcare System

University Drive C, Pittsburgh, PA 15240

Email: Robert.muder@va.gov

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