Stenotrophomonas Maltophilia Treatment & Management
- Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD more...
Medical Care
- Colonization of body fluids in hospitalized patients should be minimized if possible. Foley catheters should be used only as long as necessary and should be avoided if at all possible in immunocompromised hosts predisposed to urinary tract infections, eg, patients with diabetes, SLE, or multiple myeloma.
- Colonization of respiratory secretions in intubated patients in ICUs is the rule and is difficult to prevent.
- Patient-to-patient spread of organisms may be minimized or prevented by effective infection-control measures.
Consultations
A consultation with an infectious disease specialist is essential for differentiating colonization from infection in patients with S maltophilia isolated from various body fluids.
Araoka H, Baba M, Yoneyama A. Risk factors for mortality among patients with Stenotrophomonas maltophilia bacteremia in Tokyo, Japan, 1996-2009. Eur J Clin Microbiol Infect Dis. May 2010;29(5):605-8. [Medline].
Burdge DR, Noble MA, Campbell ME, et al. Xanthomonas maltophilia misidentified as Pseudomonas cepacia in cultures of sputum from patients with cystic fibrosis: a diagnostic pitfall with major clinical implications. Clin Infect Dis. Feb 1995;20(2):445-8. [Medline].
Denton M. Stenotrophomonas maltophilia: An emerging problem in cystic fibrosis patients. Rev Med Microbiol. 1997;8:15-9.
Hadjiliadis D, Steele MP, Chaparro C, et al. Survival of lung transplant patients with cystic fibrosis harboring panresistant bacteria other than Burkholderia cepacia, compared with patients harboring sensitive bacteria. J Heart Lung Transplant. Aug 2007;26(8):834-8. [Medline].
Paschoal IA, de Oliveira Villalba W, Bertuzzo CS, et al. Cystic fibrosis in adults. Lung. Mar-Apr 2007;185(2):81-7. [Medline].
Colin AA, Rabin HR. Stenotrophomonas maltophilia in cystic fibrosis: guilty or innocent?. Am J Respir Crit Care Med. Mar 1 2011;183(5):564-6. [Medline].
Gopalakrishnan R, Hawley HB, Czachor JS, et al. Stenotrophomonas maltophilia infection and colonization in the intensive care units of two community hospitals: A study of 143 patients. Heart Lung. Mar-Apr 1999;28(2):134-41. [Medline].
Farrell DJ, Sader HS, Jones RN. Antimicrobial susceptibilities of a worldwide collection of Stenotrophomonas maltophilia isolates tested against tigecycline and agents commonly used for S. maltophilia infections. Antimicrob Agents Chemother. Jun 2010;54(6):2735-7. [Medline]. [Full Text].
Gülmez D, Cakar A, Sener B, Karakaya J, Hasçelik G. Comparison of different antimicrobial susceptibility testing methods for Stenotrophomonas maltophilia and results of synergy testing. J Infect Chemother. Oct 2010;16(5):322-8. [Medline].
Abbott IJ, Slavin MA, Turnidge JD, Thursky KA, Worth LJ. Stenotrophomonas maltophilia: emerging disease patterns and challenges for treatment. Expert Rev Anti Infect Ther. Apr 2011;9(4):471-88. [Medline].
Alonso A, Martínez JL. Multiple antibiotic resistance in Stenotrophomonas maltophilia. Antimicrob Agents Chemother. May 1997;41(5):1140-2. [Medline].
Ansari SR, Hanna H, Hachem R, et al. Risk factors for infections with multidrug-resistant Stenotrophomonas maltophilia in patients with cancer. Cancer. Jun 15 2007;109(12):2615-22. [Medline].
Barchitta M, Cipresso R, Giaquinta L, Romeo MA, Denaro C, Pennisi C, et al. Acquisition and spread of Acinetobacter baumannii and Stenotrophomonas maltophilia in intensive care patients. Int J Hyg Environ Health. May 2009;212(3):330-7. [Medline].
Belvisi V, Fabietti P, Del Borgo C, Marocco R, DI Vincenzo E, Soscia F, et al. Successful treatment of Stenotrophomonas maltophilia soft tissue infection with tigecycline: a case report. J Chemother. Jun 2009;21(3):367-8. [Medline].
Berbari N, Johnson DH, Cunha BA. Xanthomonas maltophilia peritonitis in a patient undergoing peritoneal dialysis. Heart Lung. May-Jun 1993;22(3):282-3. [Medline].
Blanquer D, De Otero J, Padilla E, Gómez F, Mayol A, Irigaray R, et al. Tigecycline for treatment of nosocomial-acquired pneumonia possibly caused by multi-drug resistant strains of Stenotrophomonas maltophilia. J Chemother. Dec 2008;20(6):761-3. [Medline].
Cunha BA. Antibiotic Essentials. 5th ed. Royal Oak, Mich: Physicians Press; 2006.
Cunha BA. Pseudoinfections and pseudo-outbreaks. In: Mayhall G, ed. Hospital Epidemiology and Infection Control. 2nd ed. Philadelphia, Pa: Lippencott Williams and Wilkins; 1999:121-30.
Cunha BA. Infections caused by non-fermentative aerobic gram-negative bacilli in the Critical Care Unit. Antibiotics for Clinicians. 2000;4:11-6.
Cunha BA. Pneumoniae Essentials. 2nd Ed. Royal Oak, MI: Physicians Press; 2008.
Cunha BA, Klein NC. Pseudoinfections: A review. Infect Dis Clin Pract. 1995;4:95-103.
Denton M, Kerr KG. Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia. Clin Microbiol Rev. Jan 1998;11(1):57-80. [Medline].
Elting LS, Bodey GP. Septicemia due to Xanthomonas species and non-aeruginosa Pseudomonas species: increasing incidence of catheter-related infections. Medicine (Baltimore). Sep 1990;69(5):296-306. [Medline].
Elting LS, Khardori N, Bodey GP, et al. Nosocomial infection caused by Xanthomonas maltophilia: a case-control study of predisposing factors. Infect Control Hosp Epidemiol. Mar 1990;11(3):134-8. [Medline].
Entenza JM, Moreillon P. Tigecycline in combination with other antimicrobials: a review of in vitro, animal and case report studies. Int J Antimicrob Agents. Jul 2009;34(1):8.e1-9. [Medline].
Falagas ME, Kastoris AC, Vouloumanou EK, Dimopoulos G. Community-acquired Stenotrophomonas maltophilia infections: a systematic review. Eur J Clin Microbiol Infect Dis. Jul 2009;28(7):719-30. [Medline].
Falagas ME, Valkimadi PE, Huang YT, Matthaiou DK, Hsueh PR. Therapeutic options for Stenotrophomonas maltophilia infections beyond co-trimoxazole: a systematic review. J Antimicrob Chemother. Nov 2008;62(5):889-94. [Medline].
Fang FC, Madinger NE. Resistant nosocomial gram-negative bacillary pathogens: Acinetobacter baumannii, Xanthomonas maltophilia, and Pseudomonas cepacia. Curr Clin Top Infect Dis. 1996;16:52-83. [Medline].
Fujita J, Yamadori I, Xu G, et al. Clinical features of Stenotrophomonas maltophilia pneumonia in immunocompromised patients. Respir Med. Jan 1996;90(1):35-8. [Medline].
Garcia-Rodriguez JA, Garcia Sanchez JE, Munoz Bellido JL, et al. In-vitro activity of meropenem, a new carbapenem, against imipenem-resistant Pseudomonas aeruginosa and Xanthomonas maltophilia. J Chemother. Jun 1991;3(3):143-6. [Medline].
Garcia-Teresa MA, Casado-Flores J, Delgado Dominguez MA, et al. Infectious complications of percutaneous central venous catheterization in pediatric patients: a Spanish multicenter study. Intensive Care Med. Mar 2007;33(3):466-76. [Medline].
Garrison MW, Anderson DE, Campbell DM, et al. Stenotrophomonas maltophilia: emergence of multidrug-resistant strains during therapy and in an in vitro pharmacodynamic chamber model. Antimicrob Agents Chemother. Dec 1996;40(12):2859-64. [Medline].
Gilardi GL. Characterization of nonfermentative nonfastidious gram negative bacteria encountered in medical bacteriology. J Appl Bacteriol. Sep 1971;34(3):623-44. [Medline].
Gilardi GL. Infrequently encountered Pseudomonas species causing infection in humans. Ann Intern Med. Aug 1972;77(2):211-5. [Medline].
Gilardi GL. Pseudomonas maltophilia infections in man. Am J Clin Pathol. Jan 1969;51(1):58-61. [Medline].
Cunha Ba. Infectious Disease in Critical Care Medicine. 2nd Ed. New York, NY: Informa Healthcare; 2007.
Kagen J, Zaoutis TE, McGowan KL, et al. Bloodstream infection caused by Stenotrophomonas maltophilia in children. Pediatr Infect Dis J. Jun 2007;26(6):508-12. [Medline].
Khardori N, Elting L, Wong E. Nosocomial infections due to Xanthomonas maltophilia (Pseudomonas maltophilia) in patients with cancer. Rev Infect Dis. Nov-Dec 1990;12(6):997-1003. [Medline].
Khardori N, Reuben A, Rosenbaum B, et al. In vitro susceptibility of Xanthomonas (Pseudomonas) maltophilia to newer antimicrobial agents. Antimicrob Agents Chemother. Aug 1990;34(8):1609-10. [Medline].
Krcmery V, Antal M, Langsadl L, et al. Transferable amikacin resistance in pseudomonas maltophilia and acinetobacter calcoaceticus. Infection. Mar-Apr 1985;13(2):89-90. [Medline].
Looney WJ, Narita M, Mühlemann K. Stenotrophomonas maltophilia: an emerging opportunist human pathogen. Lancet Infect Dis. May 2009;9(5):312-23. [Medline].
Matsuyama JR, Beail B, Wallis C, et al. Susceptibility of Xanthomonas maltophilia and amikacin-resistant gram-negative bacteria to newer antimicrobials. Clin Pharm. Jul 1991;10(7):544-8. [Medline].
Morrison AJ Jr, Hoffmann KK, Wenzel RP. Associated mortality and clinical characteristics of nosocomial Pseudomonas maltophilia in a university hospital. J Clin Microbiol. Jul 1986;24(1):52-5. [Medline].
Nicodemo AC, Paez JI. Antimicrobial therapy for Stenotrophomonas maltophilia infections. Eur J Clin Microbiol Infect Dis. Apr 2007;26(4):229-37. [Medline].
Nseir S, Di Pompeo C, Brisson H, et al. Intensive care unit-acquired Stenotrophomonas maltophilia: incidence, risk factors, and outcome. Crit Care. 2006;10(5):R143. [Medline].
Sattler CA, Mason EO Jr, Kaplan SL. Nonrespiratory Stenotrophomonas maltophilia infection at a children's hospital. Clin Infect Dis. Dec 2000;31(6):1321-30. [Medline].
Semel JD, Trenholme GM, Harris AA, et al. Pseudomonas maltophilia pseudosepticemia. Am J Med. Mar 1978;64(3):403-6. [Medline].
Shigemura K, Arakawa S, Tanaka K, Fujisawa M. Clinical investigation of isolated bacteria from urinary tracts of hospitalized patients and their susceptibilities to antibiotics. J Infect Chemother. Feb 2009;15(1):18-22. [Medline].
Steere AC, Tenney JH, Mackel DC. Pseudomonas species bacteremia caused by contaminated normal human serum albumin. J Infect Dis. May 1977;135(5):729-35. [Medline].
Sutter VL. Identification of Pseudomonas species isolated from hospital environment and human sources. Appl Microbiol. Oct 1968;16(10):1532-8. [Medline].
Villarino ME, Stevens LE, Schable B, et al. Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients. Infect Control Hosp Epidemiol. Apr 1992;13(4):201-6. [Medline].
Wilsher ML, Kolbe J, Morris AJ, et al. Nosocomial acquisition of Burkholderia gladioli in patients with cystic fibrosis. Am J Respir Crit Care Med. Apr 1997;155(4):1436-40. [Medline].
Wishart MM, Riley TV. Infection with Pseudomonas maltophilia hospital outbreak due to contaminated disinfectant. Med J Aust. Nov 6 1976;2(19):710-2. [Medline].
Yu VL, Rumans LW, Wing EJ, et al. Pseudomonas maltophilia causing heroin-associated infective endocarditis. Arch Intern Med. Nov 1978;138(11):1667-71. [Medline].
| Infection | Predisposing Factor |
| Catheter-associated bacteriuria | Indwelling urinary catheters |
| Intravenous line infections | Central intravenous catheters |
| Urosepsis | Urinary tract instrumentation |
| Primary bacteremia | Arterial monitoring devices |
| Pseudobacteremia | Contamination of blood during collection/processing of blood cultures |

