Denton M, Kerr K G
Department of Microbiology, University of Leeds, United Kingdom.
Clin Microbiol Rev. 1998 Jan;11(1):57-80. doi: 10.1128/CMR.11.1.57.
The gram-negative bacterium Stenotrophomonas maltophilia is increasingly recognized as an important cause of nosocomial infection. Infection occurs principally, but not exclusively, in debilitated and immunosuppressed individuals. Management of S. maltophilia-associated infection is problematic because many strains of the bacterium manifest resistance to multiple antibiotics. These difficulties are compounded by methodological problems in in vitro susceptibility testing for which there are, as yet, no formal guidelines. Despite its acknowledged importance as a nosocomial pathogen, little is known of the epidemiology of S. maltophilia, and although it is considered an environmental bacterium, its sources and reservoirs are often not readily apparent. Molecular typing systems may contribute to our knowledge of the epidemiology of S. maltophilia infection, thus allowing the development of strategies to interrupt the transmission of the bacterium in the hospital setting. Even less is known of pathogenic mechanisms and putative virulence factors involved in the natural history of S. maltophilia infection and this, coupled with difficulties in distinguishing colonization from true infection, has fostered the view that the bacterium is essentially nonpathogenic. This article aims to review the current taxonomic status of S. maltophilia, and it discusses the laboratory identification of the bacterium. The epidemiology of the organism is considered with particular reference to nosocomial outbreaks, several of which have been investigated by molecular typing techniques. Risk factors for acquisition of the bacterium are also reviewed, and the ever-expanding spectrum of clinical syndromes associated with S. maltophilia is surveyed. Antimicrobial resistance mechanisms, pitfalls in in vitro susceptibility testing, and therapy of S. maltophilia infections are also discussed.
嗜麦芽窄食单胞菌这种革兰氏阴性菌日益被认为是医院感染的重要病因。感染主要（但并非仅仅）发生在身体虚弱和免疫抑制的个体中。嗜麦芽窄食单胞菌相关感染的管理存在问题，因为该菌的许多菌株对多种抗生素表现出耐药性。体外药敏试验中的方法学问题使这些困难更加复杂，目前尚无针对此的正式指南。尽管嗜麦芽窄食单胞菌作为医院病原体的重要性已得到公认，但对其流行病学知之甚少，并且尽管它被认为是一种环境细菌，但其来源和宿主往往并不容易明确。分子分型系统可能有助于我们了解嗜麦芽窄食单胞菌感染的流行病学，从而制定策略以阻断该菌在医院环境中的传播。对于嗜麦芽窄食单胞菌感染自然史中涉及的致病机制和假定的毒力因子了解更少，再加上难以区分定植与真正感染，这使得人们认为该菌本质上无致病性。本文旨在综述嗜麦芽窄食单胞菌当前的分类学地位，并讨论该菌的实验室鉴定。特别参考医院感染暴发情况来考虑该菌的流行病学，其中一些暴发已通过分子分型技术进行了调查。还综述了获得该菌的危险因素，并概述了与嗜麦芽窄食单胞菌相关的不断扩大的临床综合征谱。此外，还讨论了抗菌药物耐药机制、体外药敏试验中的陷阱以及嗜麦芽窄食单胞菌感染的治疗。
