The Clinical Spectrum of Stenotrophomonas (Xanthomonas) Maltophilia Respiratory Infection

ABSTRACT

During a 15-month retrospective clinical study in an academic referral-based cancer center, 26 patients with S. maltophilia respiratory tract infections were identified (which were associated with bacteremia in 13 patients). Five of these 26 patients had previously undescribed sinopulmonary involvement. The infections were typically nosocomial. Nine patients with solid tumors had malignant involvement of the respiratory tract (five with obstruction). In two patients, the infection co-existed with pulmonary aspergillosis. Fifteen patients (58%) died of the infection. The factors that correlated with a poor outcome included bacteremic pneumonia, persistent neutropenia, presence of obstruction, development of septic shock or multiple organ dysfunction, and delay in institution of appropriate antibiotic therapy. In multivariate analysis, only septic shock and delayed therapy remained significant. Trimethoprim-sulfamethoxazole and/or ticarcillin-clavulanate were most commonly associated with a favorable outcome.

KEYWORD

Stenotrophomonas maltophilia, Multidrug-resistance - trimethoprim-sulfamethoxazole

REFERENCES

• 1 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
• 2 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
• 3 Vartivarian S E, Papadakis K A, Palacios J A, Manning Jr T J, Anaissie E J. Mucocutaneous and soft tissue infections caused by Xanthomonas maltophilia. A new spectrum.  Ann Intern Med . 1994;  121 969-973
• 4 Papadakis K A, Vartivarian S E, Vassilaki M E, Anaissie E J. Stenotrophomonas maltophilia: An unusual cause of biliary sepsis.  Clin Infect Dis . 1995;  21 1032-1034
• 5 Vartivarian S E, Papadakis K A, Anaissie E J. Stenotrophomonas (Xanthomonas) maltophilia urinary tract infection. A disease that is usually severe and complicated.  Arch Intern Med . 1996;  156 433-435
• 6 VanCouwenberghe C J, Farver T B, Cohen S H. Risk factors associated with isolation of Stenotrophomonas (Xanthomonas) maltophilia in clinical specimens.  Infect Control Hosp Epidemiol . 1997;  18 316-321
• 7 Gopalakrishnan R, Hawley H B, Czachor J S, Markert R J, Bernstein J M. Stenotrophomonas maltophilia infection and colonization in the intensive care units of two community hospitals: A study of 143 patients.  Heart Lung . 1999;  28 134-141
• 8 Vartivarian S E, Anaissie E J. Stenotrophomonas maltophilia and Burkholderia cepacia In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases, 5th ed. Vol. 2. Philadelphia: Churchill Livingstone;2000;2335- 2339
• 9 Demko C A, Stern R C, Doershuk C F. Stenotrophomonas maltophilia in cystic fibrosis: Incidence and prevalence.  Pediatr Pulmonol . 1998;  25 304-308
• 10 Franzetti F, Cernuschi M, Esposito R, Moroni M. Pseudomonas infections in patients with AIDS and AIDS-related complex.  J Intern Med . 1992;  231 437-443
• 11 Sarkar T K, Gilardi G, Aguam A S, Josephson J, Leventhal G L. Primary Pseudomonas maltophilia infection of the lung.  Postgrad Med. 1979;  65 253-256 260
• 12 Liaw Y S, Yang P C, Wu Z G. The bacteriology of obstructive pneumonitis. A prospective study using ultrasound-guided transthoracic needle aspiration.  Am J Respir Crit Care Med . 1994;  149 1648-1653
• 13 Spencer R C. The emergence of epidemic, multiple-antibiotic-resistant Stenotrophomonas (Xanthomonas) maltophilia and Burkholderia (Pseudomonas) cepacia.  J Hosp Infect . 1995;  30 453-464
• 14 Bone R C. Gram-positive organisms and sepsis.  Arch Intern Med . 1994;  154 26-34
• 15 Zuravleff J J, Yu V L. Infections caused by Pseudomonas maltophilia with emphasis on bacteremia: Case reports and a review of the literature.  Rev Infect Dis . 1982;  4 1236-1246
• 16 Gardner P, Griffin W B, Swartz M N, Kunz L J. Nonfermentative gram-negative bacilli of nosocomial interest.  Am J Med . 1970;  48 735-749
• 17 Pennington J E, Reynolds H Y, Carbone P P. Pseudomonas pneumonia. A retrospective study of 36 cases.  Am J Med . 1973;  55 155-160
• 18 Phair J P, Bassaris H P, Williams J E, Metzger E. Bacteremic pneumonia due to gram-negative bacilli.  Arch Intern Med . 1983;  143 2147-2149
• 19 Karnad A, Alvarez S, Berk S L. Pneumonia caused by gram-negative bacilli.  Am J Med . 1985;  79 61-67
• 20 Rose H D, Heckman M G, Unger J D. Pseudomonas aeruginosa pneumonia in adults.  Am Rev Respir Dis . 1973;  107 416-422
• 21 Jonas M, Cunha B A. Bacteremic Escherichia coli pneumonia.  Arch Intern Med . 1982;  142 2157-2159
• 22 Niederman M S. Gram-negative colonization of the respiratory tract: Pathogenesis and clinical consequences.  Semin Respir Infect . 1990;  5 173-184
• 23 Davin-Regli A, Bollet C, Auffray J P, Saux P, De Micco P. Use of random amplified polymorphic DNA for epidemiological typing of Stenotrophomonas maltophilia.  J Hosp Infect . 1996;  32 39-50
• 24 Vartivarian S E, Papadakis K, Anaissie E J. Outcome of Stenotrophomonas maltophilia infection sin cancer patients. In: Interscience Conference on Antrimicrobial agents and Chemotherapy; 1997 Sept 28-Oct 1, Toronto, Ontario, Canada
• 25 Villarino M E, Stevens L E, Schable B. Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients.  Infect Control Hosp Epidemiol . 1992;  13 201-206
• 26 Nagai T. Association of Pseudomonas maltophilia with malignant lesions.  J Clin Microbiol . 1984;  20 1003-1005
• 27 Hutchinson G R, Parker S, Pryor J A. Home-use nebulizers: A potential primary source of Burkholderia cepacia and other colistin-resistant, gram-negative bacteria in patients with cystic fibrosis [published erratum appears in J Clin Microbiol 1996;34(6):1601].  J Clini Microbiol . 1996;  34 584-587
• 28 Vartivarian S E, Papadakis K A, Palacios J A, Manning Jr T J, Anaissie E J. Mucocutaneous and soft tissue infections caused by Xanthomonas maltophilia. A new spectrum.  Ann Intern Med . 1994;  121 969-973
• 29 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