Abstract
Stenotrophomonas maltophilia is an aerobic, oxidase-negative and catalase-positive bacillus. S. maltophilia is a recognized opportunistic pathogen. Due to the advancements in invasive medical procedures, organ transplantation and chemotherapy of malignant illnesses, the relevance of this pathogen increased significantly. The therapy of S. maltophilia infections is challenging, as these bacteria show intrinsic resistance to multiple classes of antibiotics, the first-choice drug is sulfamethoxazole/trimethoprim. Our aim was to assess the epidemiology of S. maltophilia from various clinical samples and the characterization of resistance-levels and resistotyping of these samples over a long surveillance period. The study included S. maltophilia bacterial isolates from blood culture samples, respiratory samples and urine samples and the data for the samples, received between January 2008 until December 2017, a total of 817 S. maltophilia isolates were identified (respiratory samples n = 579, 70.9%, blood culture samples n = 175, 21.4% and urine samples n = 63, 7.7%). Levofloxacin and colistin-susceptibility rates were the highest (92.2%; n = 753), followed by tigecycline (90.5%, n = 739), the first-line agent sulfamethoxazole/trimethoprim (87.4%, n = 714), while phenotypic resistance rate was highest for amikacin (72.5% of isolates were resistant, n = 592). The clinical problem of sulfamethoxazole/trimethoprim-resistance is a complex issue, because there is no guideline available for the therapy of these infections.
Highlights
Antimicrobial resistance (AMR) in Gram-negative bacteria is a major public health concern, severely limiting therapeutic options in clinical settings [1]
The incidence of S. maltophilia infections in nosocomial settings is reported to be around 7–38 cases/ 10,000 discharges, and it is a frequent cause of outbreaks at intensive care units; in addition, increasing amount of reports highlight the role of these bacteria in community-acquired infections as well [11, 12]
It was hypothesized that S. maltophilia infections are characterized by the lack of an inflammatory response, this dogma has been recently challenged in a murine model, where it was shown that airway epithelial cells and macrophages react with an increased expression of IL-8 and TNF-a [35]
Summary
Antimicrobial resistance (AMR) in Gram-negative bacteria is a major public health concern, severely limiting therapeutic options in clinical settings [1]. While the emergence of plasmidmediated resistance to extended-spectrum cephalosporins (due to AmpC- and extendedspectrum-b-lactamases) [2, 3], carbapenems (due to serine- and metallo-b-lactamases) [4], and colistin in the members of the Enterobacterales order (predominantly in Klebsiella pneumoniae) has taken center-stage in the last few years [5], the clinical problem of infections due to drug resistant non-fermenting Gram-negative bacteria (NFGNB) has been recognized since the beginning of the 21st century [6]. Due to the advancements in invasive medical procedures, organ transplantation and chemotherapy of malignant illnesses, the relevance of this pathogen increased significantly since the 2000's (in correlation with the increased number of patients at risk to develop infections by bacteria with low virulence) [10]. The colonization of cystic fibrosis patients with S. maltophilia has been extensively described, often leading to more frequent exacerbations and worse outcomes [17]
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