Nicodemo A C, Paez J I Garcia
Department of Infectious Diseases, University of São Paulo Medical School, São Paulo, SP, Brazil.
Eur J Clin Microbiol Infect Dis. 2007 Apr;26(4):229-37. doi: 10.1007/s10096-007-0279-3.
Stenotrophomonas maltophilia has emerged as an important nosocomial pathogen capable of causing respiratory, bloodstream, and urinary infections. The treatment of nosocomial infections by S. maltophilia is difficult, as this pathogen shows high levels of intrinsic or acquired resistance to different antimicrobial agents, drastically reducing the antibiotic options available for treatment. Intrinsic resistance may be due to reduced outer membrane permeability or to the multidrug efflux pumps. However, specific mechanisms of resistance such as aminoglycoside-modifying enzymes or the heterogeneous production of metallo-beta-lactamase have contributed to the multidrug-resistant phenotype displayed by this pathogen. Moreover, the lack of standardized susceptibility tests and their interpretative criteria hinder the choice of an adequate antibiotic treatment. Recommendations for the treatment of infections by S. maltophilia are based on in vitro studies, certain nonrandomized clinical trials, and anecdotal experience. Trimethoprim-sulfamethoxazole remains the drug of choice, although in vitro studies indicate that ticarcillin-clavulanic acid, minocycline, some of the new fluoroquinolones, and tigecycline may be useful agents. This review describes the main resistance mechanisms, the in vitro susceptibility profile, and treatment options for S. maltophilia infections.
嗜麦芽窄食单胞菌已成为一种重要的医院病原体，能够引起呼吸道、血流和泌尿系统感染。嗜麦芽窄食单胞菌引起的医院感染治疗困难，因为这种病原体对不同抗菌药物表现出高度的固有或获得性耐药性，大大减少了可用于治疗的抗生素选择。固有耐药性可能是由于外膜通透性降低或多药外排泵所致。然而，诸如氨基糖苷类修饰酶或金属β-内酰胺酶的异质性产生等特定耐药机制导致了该病原体呈现出多重耐药表型。此外，缺乏标准化的药敏试验及其解释标准阻碍了适当抗生素治疗的选择。嗜麦芽窄食单胞菌感染的治疗建议基于体外研究、某些非随机临床试验和经验性观察。甲氧苄啶-磺胺甲恶唑仍然是首选药物，尽管体外研究表明替卡西林-克拉维酸、米诺环素、一些新型氟喹诺酮类药物和替加环素可能是有效的药物。本文综述了嗜麦芽窄食单胞菌感染的主要耐药机制、体外药敏情况及治疗选择。
