Stenotrophomonas maltophilia: Difference between revisions
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Stenotrophomonas maltophilia
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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) |
**[[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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Revision as of 10:07, 20 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 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
