Stenotrophomonas

Maltophilia
Barry K. Seebo
Description

• Non-fermenting, gram negative, bacillus

that is motile with a few polar flagella,
with a high rate of local mutation
• Changed classification numerous times
• Bacterium booker 1943
• Pseudomonas maltophilia 1961
• Xanthomonas maltophilia 1983
• Stenotrophomonas maltophilia
1999.
• Multi-drug resistant with high morbidity
and mortality rates
 • Particularly abundant in immunocompromised
patients
• Chronic respiratory diseases, hematologic
malignancy, chemotherapy, organ transplants,
HIV, hemodialysis, and neonates.
• While sources exist in the environment, the main
Pathogenesis vector appears to be health care related
• Prolonged intensive care, mechanical ventilation,
tracheotomies, central venous catheters, and the
use of broad-spectrum antibiotics.
• Faucets, sinks, showers, air-conditioning, ice
makers, disinfectants, IV fluids, blood collection
tubes, nebulizers, scopes, dental equipment, lens
care systems, and hands of health care workers.
Pathogenesis
(cont.)
• Infections associated with S.
maltophilia include respiratory
tract infections (pneumonia and
acute exacerbations of chronic
obstructive pulmonary disease
[COPD]; biliary sepsis; infections
of the bones and joints, urinary
tract, and soft tissues;
endophthalmitis; eye infections
(keratitis, scleritis, and
dacryocystitis); endocarditis; and
meningitis
 Diagnosis
• The main problem is the clinical manifestations
are non-specific and therefore are not
distinguishable form other infections.
• One characteristic is late-onset hospital acquired
pneumonia or bacteriemia.
• Once isolated, it grows on standard media
cultures
• Typically presents as yellow green on agar,
lavender on blood agar.
• In vivo, generally oxidase negative, indole, HS,
and urase are also negative.
• Positives include: catalase, DNase, and lysine
decarboxylase.
 Diagnosis (cont.)
• Because of its antibiotic resistance, this
poses a secondary diagnostic challenge.
• It does not have a stable minimum
inhibitory concentration in regards to
numerous antibiotics.
• Currently trimethoprim-
sulfamethoxazole, levofloxacin, and
minocycline are the standard
• The most accurate methods of
identification are PCR and mass
spectrometry.
 Treatment
• The first line of treatment is specific antibiotic treatment.
• Trimethoprim-sulfamethoxazole at 15mg/kg is the standard
• While this seems to treat 90% of infections, resistance is
rising.
• It is contraindicated on patients with hypersensitivity,
hyperkalemia, deterioration of kidney function, and bone-
marrow suppression.
• Alternatives are levofloxacin, and the variety of newer floxacins.
• Secondary is the use of minocycline ad tigecycline
 Prognosis
• The main problem seems to be coinfection
by isolates or multiple resistant strains.
• Some isolates have shown resistance to all
known treatments.
• The crude mortality rate is 14-69%.
• The creation of biofilms makes sterilization
difficult.
Facts
• It is the only of the 17 known Stenophomonas that
affect humans
• It is the infection that started my mothers decline this
semester.
• Brooke J. S. (2012). Stenotrophomonas maltophilia: an
emerging global opportunistic pathogen. Clinical microbiology
reviews, 25(1), 2–41. https://doi.org/10.1128/CMR.00019-11
• Said, M. S. (2021, September 28). Stenotrophomonas
Maltophilia. National Library of Medicine. Retrieved May 2, 2022,
from https://www.ncbi.nlm.nih.gov/books/NBK572123/
• Murray PR, Rosenthal KS, Pfaller MA (2021) Medical
Microbiology. Elsevier, Amsterdam