Stenotrophomonas maltophilia biofilm: its role in infectious diseases

ABSTRACT

Introduction: Infections caused by the opportunistic Stenotrophomonas maltophilia pathogen in immunocompromised patients are complicated to treat due to antibiotic resistance and the ability of the bacteria to produce biofilm.

Areas covered: A MEDLINE/PubMed search was performed of available literature to describe the role of biofilm produced by S. maltophilia in the diseases it causes, including biofilm-influencing factors, the biofilm forming process and composition. The antimicrobial resistance due to S. maltophilia biofilm production and current antibiofilm strategies is also included.

Expert opinion: Through the production of biofilm, S. maltophilia strains can easily adhere to the surfaces in hospital settings and aid in its transmission. The biofilm can also cause antibiotic tolerance rendering some of the therapeutic options ineffective, causing setbacks in the selection of an appropriate treatment. Conventional susceptibility tests do not yet offer therapeutic guidelines to treat biofilm-associated infections. Current S. maltophilia biofilm control strategies include natural and synthetic compounds, chelating agents, and commonly prescribed antibiotics. As biofilm age and matrix composition affect the level of antibiotic tolerance, their characterization should be included in biofilm susceptibility testing, in addition to molecular and proteomic analyzes. As for now, several commonly recommended antibiotics can be used to treat biofilm-related S. maltophilia infections.

KEYWORDS:

• Antibiofilm agent
• biofilm
• biofilm formation
• biofilm-related infection
• extracellular polymeric substances (EPS) composition
• Stenotrophomonas maltophilia

Article highlights

• Stenotrophomonas maltophilia, a with low virulence and high drug resistance, is responsible for nosocomial infections in immunocompromised patients.

• Virulence factors of S. maltophilia include extracellular enzymes, lipopolysaccharides, fimbriae, adhesins, flagella, and biofilm.

• S. maltophilia biofilm is a bacterial sessile community attached to a surface and embedded in a self‐produced polymeric matrix composed of a mixture of polysaccharides, proteins, nucleic acids, and lipids.

• Bacteria within biofilms are protected from the host immune system and antibiotics, but this trait varies by matrix composition, specific antimicrobial agent, and biofilm age.

• Environmental factors such as temperature, pH, CO₂ concentration, glucose concentration, iron limitation, and static or dynamic conditions influence biofilm formation in S. maltophilia.

• The stages of biofilm formation process are adherence, attachment, and maturation.

• The production of biofilm greatly contributes to the disease progression in the respiratory tract of patients with cystic fibrosis.

• Among potential antibiofilm agents, commonly prescribed antibiotics (e.g. fluoroquinolones, macrolides in combination with other antibiotics, polymyxins, aminoglycosides and folate pathway inhibitors) show promising results on S. maltophilia.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the Fondo Sectorial de Investigación para la Educación of the Consejo Nacional de Ciencia y Tecnología (CONACyT) under Grant number 284041.