Abstract
Stenotrophomonas maltophilia (S. maltophilia) is a globally emerging Gram-negative bacillus that is widely spread in environment and hospital equipment. Recently, the incidence of infections caused by this organism has increased, particularly in patients with hematological malignancy and in recipients of hematopoietic stem cell transplantation (HSCT) having neutropenia, mucositis, diarrhea, central venous catheters or graft versus host disease and receiving intensive cytotoxic chemotherapy, immunosuppressive therapy, or broad-spectrum antibiotics. The spectrum of infections in HSCT recipients includes pneumonia, urinary tract and surgical site infection, peritonitis, bacteremia, septic shock, and infection of indwelling medical devices. The organism exhibits intrinsic resistance to many classes of antibiotics including carbapenems, aminoglycosides, most of the third-generation cephalosporins, and other β-lactams. Despite the increasingly reported drug resistance, trimethoprim-sulfamethoxazole is still the drug of choice. However, the organism is still susceptible to ticarcillin-clavulanic acid, tigecycline, fluoroquinolones, polymyxin-B, and rifampicin. Genetic factors play a significant role not only in evolution of drug resistance but also in virulence of the organism. The outcome of patients having S. maltophilia infections can be improved by: using various combinations of novel therapeutic agents and aerosolized aminoglycosides or colistin, prompt administration of in vitro active antibiotics, removal of possible sources of infection such as infected indwelling intravascular catheters, and application of strict infection control measures.
Highlights
Stenotrophomonas maltophilia (S. maltophilia) is a free living, motile, aerobic, oxidase negative, glucose non-fermentative Gramnegative bacillus (GNB)
Outbreaks of S. maltophilia bacteremia have been described in recipients of allogeneic hematopoietic stem cell transplantation (HSCT) having neutropenia and mechanical ventilation [9, 10]
Risk factors for S. maltophilia infection-associated mortality include: [1] severely immunocompromised hosts, those with underlying hematological malignancy (HM) and recipients of HSCT, [2] septic shock, [3] organ failure, [4] bacteremia, [5] lung involvement such as pneumonia or pulmonary hemorrhage, [6] extensively drug-resistant organism, [7] exposure to carbapenems, [8] thrombocytopenia, and [9] high acute physiology and chronic health evaluation (APACHE) score in patients admitted to the intensive care unit (ICU) [2, 5, 7,8,9, 18, 60, 125, 126]
Summary
Stenotrophomonas maltophilia (S. maltophilia) is a free living, motile, aerobic, oxidase negative, glucose non-fermentative Gramnegative bacillus (GNB). It is frequently isolated from water, soil, animals, plants, and hospital equipment [1,2,3,4,5]. S. MALTOPHILIA INFECTIONS IN RECIPIENTS OF HSCT Recipients of various forms of hematopoietic stem cell transplantation (HSCT) are at risk of a wide range of infectious complications due to their severely suppressed immunity. Peculiar risk factors predispose recipients of HSCT to S. maltophilia infections and these are included in Table 2 [2, 5, 7, 9, 10, 13, 14]. S. maltophilia infections have been described in various forms of HSCT: autologous transplant and allogeneic, sibling related, www.frontiersin.org
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