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[Clinical manifestations of Stenotrophomas (Xanthomonas) maltophilia infection]
Objective:
Stenotrophomonas maltophilia (SM) is a gram-negative bacillus whose incidence like nosocomial pathogen has been incremented in the last years, especially in immunocompromised patients, subjected to invasive procedures and those receiving broad-spectrum antimicrobial therapy.
Method:
We report 15 isolations of SM between 1994-1996.
Results:
The criteria for SM infection were fulfilled by 9 patients (60%), and 6 patients (40%) were colonized. The mean age of the patient was 60 +/- 12 years. Major predisposing factors in infections included venous catheterization (100%), prior surgery (86%), residence in ICU (80%), prior antibiotic therapy (80%) and intubation (66%). The most common underlying disease were heart disease (60%), treatment with immunosuppressors and/or steroids (46%) and chronic lung disease (46%). Ten cases (66%) had polymicrobial culture. The mortality rate was 40%. Risk factors associated with fatal outcome included the following: chronic lung disease (p = 0.043), nasogastric catheterization (p = 0.01), urinary tract catheterization (p = 0.02), intubation (p = 0.04) and the presence of pneumonia or sepsis by SM (p = 0.02). The most active agents were colistina (100%), cotrimoxazol (71%) and ceftazidima (53%). The isolates were highly resistant to first and second-generation cephalosporins (100%) tetracyclines (86%), aztreonam (91%) and imipenem (71%).
Conclusion:
SM cause a wide range of clinical syndromes and is more likely to cause infection or colonization in patients who have underlying disease. Due to its inherent multiple-antimicrobial resistance, it would appear its potential as a nosocomial pathogen will continue to increase. Therapy of patients should include cotrimoxazole.
Insights
Stenotrophomonas maltophilia (SM) is an increasing nosocomial pathogen, particularly in vulnerable patients. Cotrimoxazole is recommended for treatment due to SM's high antimicrobial resistance.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Context:
- Stenotrophomonas maltophilia (SM) is a gram-negative bacillus
- Increasing incidence as a nosocomial pathogen
- Predominantly affects immunocompromised patients, those with invasive procedures, and on broad-spectrum antibiotics
Purpose:
- To report 15 isolations of SM between 1994-1996
- Analyze predisposing factors, clinical syndromes, and outcomes of SM infections
- Evaluate antimicrobial susceptibility patterns
Summary:
- Of 15 SM isolations, 9 patients (60%) had infections and 6 (40%) were colonized
- Predisposing factors included venous catheterization (100%), prior surgery (86%), ICU residence (80%), prior antibiotics (80%), and intubation (66%)
- Mortality rate was 40%, associated with chronic lung disease, catheterization, intubation, pneumonia, or sepsis; cotrimoxazole, colistin, and ceftazidime showed activity, while isolates were resistant to many antibiotics
Impact:
- SM causes diverse clinical syndromes in patients with underlying diseases
- Inherent multidrug resistance suggests increasing potential as a nosocomial pathogen
- Therapeutic recommendations include cotrimoxazole