Abstract
Stenotrophomonas maltophilia is an emerging opportunistic pathogen and therapeutic options are limited because of intrinsic multidrug resistance. We collected S. maltophilia isolates as a part of the Antimicrobial Testing Leadership and Surveillance (ATLAS) program and determined minimuminhibitory concentrations (MICs) through broth microdilution methods. The susceptibility was interpreted according to the Clinical and Laboratory Standards Institute (CLSI) breakpoints. Isolates with tigecycline MIC ≤ 2 mg/L were defined as susceptible by using the United States Food and Drug Administration criteria of Enterobacterales. A total of 2,330 S. maltophilia isolates were collected from 47 countries worldwide during 2004-2020 in the ATLAS program. Most patients were hospitalized (92.3%, 2151/2330) and respiratory tract infections (47.8%, 1114/2330) was the leading source. Minocycline had the highest susceptibility rate (98.8%), followed by levofloxacin, TMP-SMX, and ceftazidime (85.0%, 84.4%, and 53.7%, respectively). A total of 98.3% (2290/2330) of S. maltophilia isolates had tigecycline MIC ≤ 2 mg/L. Among the S. maltophilia isolates exhibiting resistance to levofloxacin and ceftazidime, 89.3% (150/168) and 97.3% (692/711), respectively, were susceptible to tigecycline. Eight countries provided more than 30 isolates and were selected for comparison. The geographic difference in antimicrobial resistance was found for levofloxacin, minocycline, and tigecycline resistance (all p <0.05) but not for ceftazidime (p = 0.467). In conclusion, our in vitro susceptibility data demonstrated that minocycline had the best susceptible rate than ceftazidime and levofloxacin. Additionally, our findings demonstrated that tigecycline could be an alternative or salvage option for the treatment of S. maltophilia infections.
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