Stenotrophomonas maltophilia: emerging disease patterns and challenges for treatment

Abstract

Stenotrophomonas maltophilia is a ubiquitous organism associated with opportunistic infections. In the immunocompromised host, increasing prevalence and severity of illness is observed, particularly opportunistic bloodstream infections and pneumonia syndromes. In this article, the classification and microbiology are outlined, together with clinical presentation, outcomes and management of infections due to S. maltophilia. Although virulence mechanisms and the genetic basis of antibiotic resistance have been identified, a role for standardized and uniform reporting of antibiotic sensitivity is not defined. Infections due to S. maltophilia have traditionally been treated with trimethoprim–sulfamethoxazole, ticarcillin–clavulanic acid, or fluoroquinolone agents. The use of combination therapies, newer fluoroquinolone agents and tetracycline derivatives is discussed. Finally, measures to prevent transmission of S. maltophilia within healthcare facilities are reported, especially in at-risk patient populations.

Keywords::

• antibiotic resistance
• immunocompromised
• opportunistic infection
• Stenotrophomonas maltophilia
• trimethoprim–sulfamethoxazole
• virulence factors

Acknowledgements

Denis Spelman and Cameron Jeremiah (Department of Microbiology, The Alfred Hospital, Melbourne, Australia) are acknowledged for the provision of Gram-stain and culture images in Figure 1.

Financial & competing interests disclosure

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.

No writing assistance was utilized in the production of this manuscript.

Notes

^†Selective medium containing vancomycin, imipenem and amphotericin B with a mannitol/bromothymol blue indicator system [150]. Meropenem may be used in place of imipenem [151].

CF: Cystic fibrosis; COPD: Chronic obstructive pulmonary disease.