eMedicine Specialties > Infectious Diseases > Bacterial Infections

Stenotrophomonas Maltophilia

Author: Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Contributor Information and Disclosures

Updated: Oct 19, 2009

Introduction

Background

Stenotrophomonas (Pseudomonas) maltophilia is an aerobic gram-negative bacillus that is found in various aquatic environments. It is an uncommon pathogen in humans.

S maltophilia is an organism of low virulence and frequently colonizes fluids used in the hospital setting (eg, irrigation solutions, intravenous fluids) and patient secretions (eg, respiratory secretions, urine, wound exudates). S maltophilia usually must bypass normal host defenses to cause human infection. For example, if an irrigation solution becomes colonized with this organism, irrigating an open wound can cause colonization or infection of the wound. S maltophilia is usually incapable of causing disease in healthy hosts without the assistance of invasive medical devices that bypass normal host defenses.

Pathophysiology

S maltophilia has few pathogenic mechanisms and, for this reason, predominantly results in colonization rather than infection. If infection does occur, invasive medical devices are usually the vehicles through which the organism bypasses normal host defenses. Otherwise, the pathophysiology of this nonfermentative aerobic gram-negative bacillus does not differ from other nonfermentative aerobic organisms.

Frequency

United States

S maltophilia is a noninvasive organism that has low virulence. It frequently colonizes body fluids but rarely causes infection (eg, intravenous line infections).

International

S maltophilia frequently colonizes the respiratory tract in patients with cystic fibrosis.

Mortality/Morbidity

Mortality and morbidity relate to the inoculum of S maltophilia that is able to bypass normal host defense mechanisms.

  • If an intravenous infusion contains large numbers of S maltophilia, then direct injection into the bloodstream may result in the signs and symptoms associated with gram-negative bacteremia.
  • Similarly, in the urinary tract, if urological irrigation fluids that contain large numbers of S maltophilia are used during an invasive urological procedure, eg, cystoscopy, then gram-negative bacteremia may occur with its attendant mortality and morbidity, which depend on host factors.

Clinical

History

  • Because S maltophilia infections are extremely uncommon, no specific patient history suggests its presence other than contact with other colonized individuals.
  • Obtaining a history of the use of irrigant solutions that could potentially contain S maltophilia is important in an epidemiological setting rather than in a clinical setting.

Physical

Signs and symptoms of S maltophilia infections are related to the organ system involved and are indistinguishable from infections with other pathogens.

Causes

  • S maltophilia is a nonfermentative aerobic gram-negative bacillus formerly classified in the genus Pseudomonas. Unlike Pseudomonas aeruginosa, S maltophilia is an organism of low virulence with limited ability to cause infection in humans.
  • S maltophilia is a water organism, and it survives and multiplies in aqueous environments, particularly respiratory secretions, urine, intravenous fluids, and irrigant solutions.
  • S maltophilia may persist in an aquatic environment for extended periods.
  • Sources of S maltophilia colonization include the following:
    • Personnel
      • Hands
      • Antiseptic soaps
      • Hand lotion
    • Respiratory equipment and/or fluids
      • Ultrasonic nebulizers
      • Inhalation medications
      • Respirator tubing condensate
    • Intravenous lines and/or fluids
      • Intravenous solutions
      • Central venous catheters
    • Pressure monitoring devices - Pressure transducer fluids
    • Urine and/or fluids
      • Indwelling Foley catheters
      • Urometers
      • Irrigation solutions

More on Stenotrophomonas Maltophilia

Overview: Stenotrophomonas Maltophilia
Differential Diagnoses & Workup: Stenotrophomonas Maltophilia
Treatment & Medication: Stenotrophomonas Maltophilia
Follow-up: Stenotrophomonas Maltophilia
References
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Further Reading

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Keywords

Stenotrophomonas maltophilia, S maltophilia, Stenotrophomonas maltophilia infection , S maltophilia infection , Stenotrophomonas maltophilia pneumonia, S maltophilia pneumonia, Pseudomonas maltophilia infection, P maltophilia

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Contributor Information and Disclosures

Author

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Charles S Levy, MD, Associate Professor, Department of Medicine, Section of Infectious Disease, George Washington University School of Medicine
Charles S Levy, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Medical Society of the District of Columbia
Disclosure: Nothing to disclose.

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Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
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Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
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