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: @@
-== Microbiology ==
+==Background==
+===Microbiology===
-* Aerobic, non-fermentive, Gram negative, catalase positive, oxidase negative
+*Aerobic, non-fermentive, catalase [[Catalase::positive]], oxidase [[Oxidase::negative]], [[Stain::Gram-negative]] [[Shape::bacillus]]
-== Clinical Presentation ==
+*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
+*Nosocomial infections with high mortality and high antibiotic resistance
-== Management ==
+==Management==
-* Limited antibiotic options:
-** [[Levofloxacin]] (and other FQs)
+*Limited antibiotic options
-** [[TMP-SMX]] (Septra)
+*Therapy should be guided by antimicrobial susceptibility testing
-** [[Doxycycline]]
+*Antistenotrophomonal antibiotics:
-** Maybe also ticarcillin-clavulanate and [[ceftazidime]]
+**[[Is treated by::TMP-SMX]] 15 mg/kg split q8h (preferred agent, if susceptible)
+**[[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::Minocycline]], [[Is treated by::doxycycline]], and [[Is treated by::tigecycline]]
+**[[Is treated by::Ticarcillin-clavulanate]] and [[Is treated by::ampicillin-sulbactam]]
+**[[Is treated by::Ceftazidime]] and [[Is treated by::ceftazidime-avibactam]]
+**[[Is treated by::Colistin]], though high rates of resistance
+**Possibly [[Is treated by::ceftriaxone]]
 {{DISPLAYTITLE:''Stenotrophomonas maltophilia''}}