Stenotrophomonas maltophilia: Difference between revisions
From IDWiki
Stenotrophomonas maltophilia
No edit summary |
m (Text replacement - "[[Cellular shape::" to "[[Shape::") |
||
(10 intermediate revisions by the same user not shown) | |||
Line 1: | Line 1: | ||
− | == |
+ | ==Background== |
+ | ===Microbiology=== |
||
⚫ | |||
⚫ | |||
⚫ | |||
+ | *Multiple mechanisms of resistance |
||
+ | **RND, MfsA, and Sme-related efflux pumps |
||
+ | **''Sul'' or ''dfrA'' genes (TMP-SMX resistance) |
||
+ | **β-lactamases |
||
+ | **Aminoglycoside-modifying enzymes |
||
⚫ | |||
⚫ | |||
⚫ | |||
⚫ | |||
⚫ | |||
⚫ | |||
+ | |||
− | ** [[Levofloxacin]] (and other FQs) |
||
⚫ | |||
− | ** [[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''}} |
{{DISPLAYTITLE:''Stenotrophomonas maltophilia''}} |
Latest revision as of 14:24, 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