<i>Stenotrophomonas maltophilia</i> Infection in Trauma and Orthopedic Patients: Clinical Experience and Review

Abstract

Background. Stenotrophomonas maltophilia (S. maltophilia) is a gram-negative non-fermenting bacillus and is a rare pathogen of orthopedic infection. Due to the relatively low virulence of S. maltophilia, many clinicians are still faced with the question of whether this bacterial species is simply a colonizing agent or the true cause of infection.
 Aim of the study to raise the awareness of practitioners about S. maltophilia as a rare pathogen of orthopedic infection.
 Methods. A retrospective analysis was performed concerning the frequency of S. maltophilia isolation from patients treated at the Vreden Center for periprosthetic infection and/or osteomyelitis from January 1, 2009 to October 31, 2022. The literature search by keywords was carried out in the PubMed/MEDLINE, Scopus, eLIBRARY, and Cyberleninka databases. The search retrieved 587 articles published in Russian or English over the period from 2012 to November 2022.
 Results. During the study period, 9 cases of orthopedic monoinfection with S. maltophilia were identified in 9 patients aged 36 to 83 years. At the time of admission, no leukocytosis was detected in patients, and only 2 of 9 patients had elevated C-reactive protein level. S. maltophilia is naturally resistant to many broad-spectrum antibiotics. Co-trimoxazole is considered the drug of choice for the treatment of S. maltophilia infection. The limited choice of drugs for targeted therapy, the presence of multiple determinants of antibiotic resistance, the existence of microbial associations and patient risks including implantation, chronic nature of infection, elderly age, as well as the presence of significant concomitant somatic pathology can lead to the ineffectiveness of the ongoing treatment of infections caused by S. maltophilia. Our experience shows that in the case of sensitivity of S. maltophilia strain to co-trimoxazole it is possible to prescribe this drug for a long course as monotherapy, provided that the radical surgical treatment of the focus is performed.