Gutiérrez Rodero F, Masiá M M, Cortés J, Ortiz de la Tabla V, Mainar V, Vilar A
Servicio de Medicina Interna, Hospital de la Marina Baixa, Alicante, Spain.
Clin Infect Dis. 1996 Dec;23(6):1261-5. doi: 10.1093/clinids/23.6.1261.
Stenotrophomonas (Xanthomonas) maltophilia is a rare cause of endocarditis. The extensive resistance of this organism to several antibiotics leaves few options for antimicrobial therapy. In vitro synergism of the combination of trimethoprim-sulfamethoxazole (TMP-SMZ) and ticarcillin/clavulanic acid (TIC/CA) has been demonstrated. To our knowledge, we report the first case of ventriculoatrial cerebrospinal fluid shunt-associated endocarditis due to S. maltophilia. The patient was cured with combination therapy with TMP-SMZ and TIC/CA along with catheter removal. This is also the first report of S. maltophilia endocarditis successfully treated with this antibiotic combination. In a review of the medical literature, only 16 cases of S. maltophilia endocarditis were found. Most patients were intravenous drug users (43.8%) or had either prosthetic heart valves (50%) or an indwelling vascular catheter (18.8%). Although S. maltophilia is usually considered a nosocomial pathogen, about one-half of the cases were community-acquired. Twelve of sixteen patients had left-sided endocarditis. Therapy with a combination of two or more antibiotics was employed in most cases. Seven patients had been given TMP-SMZ therapy, but none had been treated with TIC/CA before. One-half of the patients required cardiac surgery. The overall mortality rate was 33%. Although the optimal antibiotic treatment for S. maltophilia endocarditis remains unknown, the case reported herein reinforces in vitro findings that the combination of TMP-SMZ and TIC/CA may be effective therapy.
嗜麦芽窄食单胞菌（黄单胞菌属）是心内膜炎的罕见病因。该菌对多种抗生素具有广泛耐药性，使得抗菌治疗选择有限。已证实甲氧苄啶 - 磺胺甲恶唑（TMP - SMZ）与替卡西林/克拉维酸（TIC/CA）联合使用具有体外协同作用。据我们所知，我们报告了首例由嗜麦芽窄食单胞菌引起的脑室 - 心房脑脊液分流相关性心内膜炎病例。该患者通过TMP - SMZ与TIC/CA联合治疗并拔除导管得以治愈。这也是首例使用该抗生素联合方案成功治疗嗜麦芽窄食单胞菌心内膜炎的报告。在医学文献回顾中，仅发现16例嗜麦芽窄食单胞菌心内膜炎病例。大多数患者为静脉吸毒者（43.8%）或患有人工心脏瓣膜（50%）或留置血管导管（18.8%）。尽管嗜麦芽窄食单胞菌通常被认为是医院病原体，但约一半的病例为社区获得性。16例患者中有12例患有左侧心内膜炎。大多数病例采用两种或更多种抗生素联合治疗。7例患者接受过TMP - SMZ治疗，但之前均未接受过TIC/CA治疗。一半的患者需要进行心脏手术。总体死亡率为33%。尽管嗜麦芽窄食单胞菌心内膜炎的最佳抗生素治疗方案仍未知，但本文报告的病例强化了体外研究结果，即TMP - SMZ与TIC/CA联合可能是有效的治疗方法。
