Huang Chi-Ren, Chen Shu-Feng, Tsai Nai-Wen, Chang Chiung-Chih, Lu Chen-Hsien, Chuang Yao-Chung, Chien Chun-Chih, Chang Wen-Neng
Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Clin Neurol Neurosurg. 2013 Sep;115(9):1709-15. doi: 10.1016/j.clineuro.2013.03.006. Epub 2013 Apr 20.
Stenotrophomonas (S.) maltophilia is an uncommon pathogen of adult bacterial meningitis (ABM).
The clinical characteristics of six S. maltophilia ABM cases, collected during a study period of nine years (2001-2009) were included. In the related literature, 13 S. maltophilia ABM cases were reported, and their clinical data were also collected.
The 19 S. maltophilia ABM cases included 11 men and 8 women, aged 28-70 years. Of these 19 cases, 89.5% (17/19) had underlying neurosurgical (NS) conditions as the preceding event. Before the development of S. maltophilia ABM, 52.6% (10/19) of them had long stays in hospital and 63.2% (12/19) had undergone antibiotic treatment. Among the implicated S. maltophilia cases, three strains were found to have a resistance to sulfamethoxazole-trimethoprim (SMZ-TMP). Two of our five cases had resistant strains to levofloxacin. Among the antibiotics chosen for treatment, SMZ-TMP was the most common followed by quinolone (ciprofloxacin, levofloxacin, moxifloxacin). The therapeutic results showed 2 cases expired while the other 17 cases survived.
S. maltophilia ABM usually develops in patients with a preceding neurosurgical condition, a long hospital stay and antibiotic use. SMZ-TMP and quinolones, especially the ciprofloxacin, are the major antibiotic used. This study also shows the emergence of clinical S. maltophilia strains which are not susceptible to SMZ-TMP and quinolones and this development may pose a more serious threat in the near future because treatment options may become depleted and limited despite the mortality rate of this specific group of ABM not being high at this time.
嗜麦芽窄食单胞菌是成人细菌性脑膜炎（ABM）的一种罕见病原体。
纳入在九年研究期间（2001 - 2009年）收集的6例嗜麦芽窄食单胞菌所致ABM病例的临床特征。在相关文献中，报道了13例嗜麦芽窄食单胞菌所致ABM病例，并收集了其临床资料。
19例嗜麦芽窄食单胞菌所致ABM病例中，男性11例，女性8例，年龄28 - 70岁。这19例病例中，89.5%（17/19）有神经外科（NS）基础疾病作为前驱事件。在嗜麦芽窄食单胞菌所致ABM发生前，其中52.6%（10/19）长期住院，63.2%（12/19）接受过抗生素治疗。在所涉及的嗜麦芽窄食单胞菌病例中，发现3株对磺胺甲恶唑 - 甲氧苄啶（SMZ - TMP）耐药。我们的5例病例中有2例对左氧氟沙星耐药。在选择用于治疗的抗生素中，SMZ - TMP最常用，其次是喹诺酮类（环丙沙星、左氧氟沙星、莫西沙星）。治疗结果显示2例死亡，其余17例存活。
嗜麦芽窄食单胞菌所致ABM通常发生在前驱有神经外科疾病、长期住院且使用过抗生素的患者中。SMZ - TMP和喹诺酮类，尤其是环丙沙星，是主要使用的抗生素。本研究还显示出临床嗜麦芽窄食单胞菌菌株对SMZ - TMP和喹诺酮类不敏感的情况出现，尽管目前这一特定类型ABM的死亡率不高，但这种情况在不久的将来可能构成更严重的威胁，因为治疗选择可能会变得匮乏和受限。
