Stenotrophomonas maltophilia: Difference between revisions

Latest revision as of 18:24, 13 October 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 15 mg/kg split q8h (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
- Colistin, though high rates of resistance
- Possibly ceftriaxone

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
 ===Microbiology===
-*Aerobic, non-fermentive, [[Catalase test::catalase-positive]], [[Oxidase test::oxidase-negative]], [[Stain::Gram-negative]] [[Cellular shape::bacillus]]
+*Aerobic, non-fermentive, catalase [[Catalase::positive]], oxidase [[Oxidase::negative]], [[Stain::Gram-negative]] [[Shape::bacillus]]
 *Multiple mechanisms of resistance
 **RND, MfsA, and Sme-related efflux pumps
 **''Sul'' or ''dfrA'' genes (TMP-SMX resistance)
 **β-lactamases
 **Aminoglycoside-modifying enzymes
@@ Line 19: / Line 19: @@
 *Therapy should be guided by antimicrobial susceptibility testing
 *Antistenotrophomonal antibiotics:
-**[[TMP-SMX]] (preferred agent, if susceptible)
+**[[Is treated by::TMP-SMX]] 15 mg/kg split q8h (preferred agent, if susceptible)
-**[[Fluoroquinolones]], including [[moxifloxacin]], [[levofloxacin]], and [[ciprofloxacin]] (though develops resistance quickly on monotherapy)
+**[[Is treated by::Fluoroquinolones]], including [[Is treated by::moxifloxacin]], [[Is treated by::levofloxacin]], and [[Is treated by::ciprofloxacin]] (though develops resistance quickly on monotherapy)
-**[[Minocycline]], [[doxycycline]], and [[tigecycline]]
+**[[Is treated by::Minocycline]], [[Is treated by::doxycycline]], and [[Is treated by::tigecycline]]
-**[[Ticarcillin-clavulanate]] and [[ampicillin-sulbactam]]
+**[[Is treated by::Ticarcillin-clavulanate]] and [[Is treated by::ampicillin-sulbactam]]
-**[[ceftazidime]] and [[ceftazidime-avibactam]]
+**[[Is treated by::Ceftazidime]] and [[Is treated by::ceftazidime-avibactam]]
+**[[Is treated by::Colistin]], though high rates of resistance
-**Possibly [[ceftriaxone]]
+**Possibly [[Is treated by::ceftriaxone]]
 {{DISPLAYTITLE:''Stenotrophomonas maltophilia''}}