Stenotrophomonas maltophilia: Difference between revisions
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Stenotrophomonas maltophilia
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== |
==Background== |
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===Microbiology=== |
===Microbiology=== |
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*Multiple mechanisms of resistance |
*Multiple mechanisms of resistance |
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**RND, MfsA, and Sme-related efflux pumps |
**RND, MfsA, and Sme-related efflux pumps |
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**''Sul'' or ''dfrA'' genes (TMP-SMX resistance) |
**''Sul'' or ''dfrA'' genes (TMP-SMX resistance) |
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**β-lactamases |
**β-lactamases |
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**Aminoglycoside-modifying enzymes |
**Aminoglycoside-modifying enzymes |
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*Antistenotrophomonal antibiotics: |
*Antistenotrophomonal antibiotics: |
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**[[TMP-SMX]] (preferred agent, if susceptible) |
**[[TMP-SMX]] (preferred agent, if susceptible) |
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**[[Fluoroquinolones]], including [[moxifloxacin]], [[levofloxacin]], and [[ciprofloxacin]] (though develops resistance quickly on monotherapy) |
**[[Fluoroquinolones]], including [[moxifloxacin]], [[levofloxacin]], and [[ciprofloxacin]] (though develops resistance quickly on monotherapy) |
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**[[Minocycline]], [[doxycycline]], and [[tigecycline]] |
**[[Minocycline]], [[doxycycline]], and [[tigecycline]] |
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**[[Ticarcillin-clavulanate]] and [[ampicillin-sulbactam]] |
**[[Ticarcillin-clavulanate]] and [[ampicillin-sulbactam]] |
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Revision as of 01:36, 17 August 2020
Background
Microbiology
- Aerobic, non-fermentive, catalase-positive, oxidase-negative, Gram-negative bacillus
- Multiple mechanisms of resistance
- RND, MfsA, and Sme-related efflux pumps
- Sul or dfrA genes (TMP-SMX resistance)
- β-lactamases
- Aminoglycoside-modifying enzymes
Clinical Manifestations
- Nosocomial infections with high mortality and high antibiotic resistance
Management
- Limited antibiotic options
- Therapy should be guided by antimicrobial susceptibility testing
- Antistenotrophomonal antibiotics:
- TMP-SMX (preferred agent, if susceptible)
- Fluoroquinolones, including moxifloxacin, levofloxacin, and ciprofloxacin (though develops resistance quickly on monotherapy)
- Minocycline, doxycycline, and tigecycline
- Ticarcillin-clavulanate and ampicillin-sulbactam
- ceftazidime and ceftazidime-avibactam
- Possibly ceftriaxone
