Abstract
BackgroundStenotrophomonas maltophilia (S. maltophilia) is an emerging opportunistic nosocomial pathogen causing various infections. The aim of our study was to characterize S. maltophilia isolates regarding phylogenetic typing, virulence factors and multidrug-resistance determinants of S. maltophilia in Iraq. MethodsA total of 3569 samples were collected from respiratory and septicemia infections. Considering guidelines given by clinical and laboratory standards institute 2018, the susceptibility of isolates was determined. The biofilm formation was performed using microtiter tissue plate (Mtp) assay. Screening of antibiotic resistance and virulence determinants was implemented using polymerase chain reaction (PCR) technique. The pulsed field gel electrophoresis (PFGE) was performed for genetic typing of strains. ResultsThe age range 55–75 years (61%, p = 0.038) was significantly more affected. Previous hospitalization and antibiotic consumption was determined among 72% (p < 0.0001) and 89% (p < 0.0001) of them, respectively. All the isolates were resistant to ceftazidime and chloramphenicol. Moreover 100% and 43% of them produced extended spectrum β-lactamases (ESBLs) and carbapenemases, respectively. We observed that 51% and 33% of S. maltophilia produced strong- and moderate-level biofilms, respectively. Additionally, 82% (p < 0.0001) of MDR strains were strong biofilm producers. Predominant resistance genes included clpA (93%), htpxA (92%), tet A (92%), tet B (89%), blaCTX-M1 (84%), blaSHV (71%) and sul1 (69%), followed by dfrA (61%), qnr (55%), MCR-1 (24%), blaIMP1 (23%), blaOXA-48 (4%) and acc (3)-IV (6.1%) genes. Furthermore, the majority of strains harbored the fliC (93%), stmPr1 (87%), tpsB (86%), plcN1 (84%), virB (73%) and fimH (69%) genes. Blood isolates carried the fliC, virB, stmPr1, pilU, hlyIII, and fimH genes, while respiratory isolates carried the rmlA, pilU and fliC genes. PFGE exhibited no genetic relation or outbreak. ConclusionWe determined S. maltophilia with vast antibiotic resistance and virulence factors in Iraq. Transmission of resistance genes to other nosocomial pathogens is a concern; hence eradication of S. maltophilia is essential.
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