Stenotrophomonas maltophilia: Difference between revisions
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Stenotrophomonas maltophilia
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===Microbiology=== |
===Microbiology=== |
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*Aerobic, non-fermentive, [[Catalase |
*Aerobic, non-fermentive, catalase [[Catalase::positive]], oxidase [[Oxidase::negative]], [[Stain::Gram-negative]] [[Shape::bacillus]] |
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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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*Therapy should be guided by antimicrobial susceptibility testing |
*Therapy should be guided by antimicrobial susceptibility testing |
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*Antistenotrophomonal antibiotics: |
*Antistenotrophomonal antibiotics: |
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**[[Is treated by::TMP-SMX]] (preferred agent, if susceptible) |
**[[Is treated by::TMP-SMX]] 15 mg/kg split q8h (preferred agent, if susceptible) |
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**[[Is treated by::Fluoroquinolones]], including [[Is treated by::moxifloxacin]], [[Is treated by::levofloxacin]], and [[Is treated by::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) |
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**[[Is treated by::Minocycline]], [[Is treated by::doxycycline]], and [[Is treated by::tigecycline]] |
**[[Is treated by::Minocycline]], [[Is treated by::doxycycline]], and [[Is treated by::tigecycline]] |
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**[[Is treated by::Ticarcillin-clavulanate]] and [[Is treated by::ampicillin-sulbactam]] |
**[[Is treated by::Ticarcillin-clavulanate]] and [[Is treated by::ampicillin-sulbactam]] |
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**[[Is treated by::Ceftazidime]] and [[Is treated by::ceftazidime-avibactam]] |
**[[Is treated by::Ceftazidime]] and [[Is treated by::ceftazidime-avibactam]] |
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**[[Is treated by::Colistin]], though high rates of resistance |
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**Possibly [[Is treated by::ceftriaxone]] |
**Possibly [[Is treated by::ceftriaxone]] |
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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
