Stenotrophomonas maltophilia: Difference between revisions
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Stenotrophomonas maltophilia
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| + | ==Background== |
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| − | == |
+ | ===Microbiology=== |
| − | * |
+ | *Aerobic, non-fermentive, catalase [[Catalase::positive]], oxidase [[Oxidase::negative]], [[Stain::Gram-negative]] [[Shape::bacillus]] |
| + | *Multiple mechanisms of resistance |
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| + | **RND, MfsA, and Sme-related efflux pumps |
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| + | **''Sul'' or ''dfrA'' genes (TMP-SMX resistance) |
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| + | **β-lactamases |
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| + | **Aminoglycoside-modifying enzymes |
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| − | == |
+ | ==Clinical Manifestations== |
| − | * |
+ | *Nosocomial infections with high mortality and high antibiotic resistance |
| − | == |
+ | ==Management== |
| − | * |
+ | *Limited antibiotic options |
| + | *Therapy should be guided by antimicrobial susceptibility testing |
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| − | ** Levofloxacin (and other FQs) |
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| + | *Antistenotrophomonal antibiotics: |
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| − | ** TMP-SMX (Septra) |
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| + | **[[Is treated by::TMP-SMX]] 15 mg/kg split q8h (preferred agent, if susceptible) |
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| − | ** Doxycycline |
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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) |
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| − | ** Maybe also ticarcillin-clavulanate and ceftazidime |
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| + | **[[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]] |
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| + | **[[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]] |
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| + | [[Category:Gram-negative bacilli]] |
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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
