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    Stenotrophomonas maltophilia is an emerging pathogen that is becoming more widespread due to antibiotic use. It is an aerobic, Gram-negative bacterium that was initially misclassified but is now the type species for its genus. S. maltophilia commonly infects immunocompromised patients through contact with medical devices and hospital environments. It is resistant to many antibiotics, making treatment difficult, and reports of infections from the bacterium have been increasing.

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    Stenotrophomonas maltophilia is an emerging pathogen that is becoming more widespread due to antibiotic use. It is an aerobic, Gram-negative bacterium that was initially misclassified but is now the type species for its genus. S. maltophilia commonly infects immunocompromised patients through contact with medical devices and hospital environments. It is resistant to many antibiotics, making treatment difficult, and reports of infections from the bacterium have been increasing.

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    905 views26 pages

    Stenotrophomonas Maltophilia: An Emerging Pathogen

    Uploaded by

    tummalapalli venkateswara rao
    Stenotrophomonas maltophilia is an emerging pathogen that is becoming more widespread due to antibiotic use. It is an aerobic, Gram-negative bacterium that was initially misclassified but is now the type species for its genus. S. maltophilia commonly infects immunocompromised patients through contact with medical devices and hospital environments. It is resistant to many antibiotics, making treatment difficult, and reports of infections from the bacterium have been increasing.

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    of 26

    STENOTROPHOMONAS MALTOPHILIA

    AN EMERGING PATHOGEN
    Dr.T.V.Rao MD

    DR.T.V.RAO MD

    STENOTROPHOMONAS MALTOPHILIA
    Stenotrophomonas maltophilia is an aerobic, nonfermentative, Gram-negative bacterium. It is an uncommon bacterium and human infection is difficult to treat. Initially classified as Pseudomonas maltophilia, S. maltophilia was also grouped in the genus Xanthomonas before eventually becoming the type species of the genus Stenotrophomonas in 1993
    DR.T.V.RAO MD

    STENOTROPHOMONAS MALTOPHILIA
    Stenotrophomonas maltophilia bacteria, Coloured transmission electron micrograph (TEM). This aerobic Gram-negative bacterium, previously known as Pseudomonas maltophilia, can cause infections in humans and is resistant to many antibiotics. It thrives in wet and moist conditions, and mainly affects patients whose immune systems have been compromised by infection or weakness. A study published in 2008 identified this bacteria as having the capacity to rapidly develop into strains with increased drug resistance..

    DR.T.V.RAO MD

    ANTIBIOTIC USE PRODUCES NEWER MICROBIAL INFECTIONS


    With the widespread use of antibiotics and dramatic improvement in patients survival, newer organisms, such as Stenotrophomonas maltophilia , Achromobacter xylosoxidans and nontuberculous mycobacteria are becoming more widespread. The reasons for their emergence are complex but may relate to the selective pressure exerted by repeated exposure to antibiotic therapy, improved laboratory isolation techniques and enhanced reporting. All may be associated with either simple colonisation or respiratory exacerbations in those persistently colonised with large numbers of these organism

    DR.T.V.RAO MD

    CHARACTERISTICS OF MALTOPHILIA
    S. maltophilia are slightly smaller (0.71.8 0.4
    0.7 micrometers) than other members of the genus. They are motile due to polar flagella and grow well on MacConkey agar producing pigmented colonies. S. maltophilia are catalase-positive, oxidase-negative (which distinguishes them from most other members of the genus) and have a positive reaction for extracellular DNase

    DR.T.V.RAO MD

    COLONIES OF STENOTROPHOMONAS MALTOPHILIA ON MACCONKEY AGAR, INCUBATION PERIOD 3 DAYS AT 30-35C

    DR.T.V.RAO MD

    COLONIES OF STENOTROPHOMONAS MALTOPHILIA ON MUELLER-HINTON AGAR. CULTIVATION 72 HOURS, AEROBIC ATMOSPHERE, 28C.

    DR.T.V.RAO MD

    BIOCHEMICAL REACTIONS
    BIOCHEMICAL REACTIONS Oxidase negative Acidifies maltose in addition to glucose, lactose ,sucrose

    DR.T.V.RAO MD

    S. MALTOPHILIA CAN LEAD TO NOSOCOMIAL INFECTIONS


    S. maltophilia is

    ubiquitous in aqueous environments, soil and

    plants, including water, urine, or respiratory secretions; it has also been used in biotechnology applications. In immunocompromised patients, S. maltophilia can lead to nosocomial infections.

    DR.T.V.RAO MD

    CATHETERS AND I V LINES A SOURCE OF INFECTION


    Most cases of infection tends to occur through use of hospital appliances such as catheters, I.V lines and breathing tubes in
    immunocompromised people.
    DR.T.V.RAO MD

    10

    EMERGING IMPORTANCE OF MALTOPHILIA


    Reports from several centres . This pathogen primarily affects patients with co-morbid illness such as cystic fibrosis, immunosuppression, organ transplantation and malignancies. Infections related to S. maltophilia are associated with high morbidity and mortality rates

    DR.T.V.RAO MD

    11

    EMERGING CONCERNS WITH STENOTROPHOMONAS MALTOPHILIA


    Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen in the debilitated host. S maltophilia is not an inherently virulent pathogen, but its ability to colonise respiratory-tract epithelial cells and surfaces of medical devices makes it a ready coloniser of hospitalised patients. S maltophilia can cause blood-stream infections and pneumonia with considerable morbidity in immunosuppressed patients. Management of infection is hampered by high-level intrinsic resistance to many antibiotic classes and the increasing occurrence of acquired resistance to the first-line drug cotrimoxazole. Prevention of acquisition and infection depends upon the application of modern infection-control practices, with emphasis on the control of antibiotic use and environmental DR.T.V.RAO MD 12 reservoirs.

    PATHOPHYSIOLOGY
    S maltophilia has few pathogenic mechanisms and, for this reason, predominantly results in colonization rather than infection. If infection does occur, invasive medical devices are usually the vehicles through which the organism bypasses normal host defenses. Otherwise, the pathophysiology of this nonfermentative aerobic gramnegative bacillus does not differ from other nonfermentative aerobic organisms.
    DR.T.V.RAO MD

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    S.MALTOPHILIA PRODUCE SEVERAL LIFE THREATING INFECTIONS


    In severely ill patients, S. maltophilia causes a wide range of infections such as bacteremia, pulmonary infections, urinary tract infections, wound infections, meningitis and endocarditis

    DR.T.V.RAO MD

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    S.MALTOPHILIA AND CYSTIC FIBROSIS


    S.maltophilia is a growing source of latent pulmonary infections. S. maltophilia colonization rates in individuals with cystic fibrosis have been increasing.
    DR.T.V.RAO MD

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    MORTALITY/MORBIDITY
    Mortality and morbidity relate to the inoculum of S maltophilia that is able to bypass normal host defense mechanisms. If an intravenous infusion contains large numbers of S maltophilia, then direct injection into the bloodstream may result in the signs and symptoms associated with gram-negative bacteremia. Similarly, in the urinary tract, if urological irrigation fluids that contain large numbers of S maltophilia are used during an invasive urological procedure, eg, cystoscopy, then gramnegative bacteremia may occur with its attendant mortality and morbidity, which depend on host factors.
    DR.T.V.RAO MD

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    TMP-SXT IS DRUG OF CHOICE ?


    TMP SXT has been recommended for use in the treatment of S. maltophilia infections based on the in vitro susceptibility data which confirm its high activity and the favorable outcomes observed in patients treated with this agent [ . Although the role of the combination antimicrobial therapy in treating infections due to strains that are susceptible to TMP SXT is uncertain but the addition of one or more agents to which the isolate is susceptible in vitro is a reasonable consideration if the patient is critically ill or has an underlying hematological malignancy
    17

    DR.T.V.RAO MD

    RESISTANCE TO TMP-SXT
    Several reports have shown that the prevalence of strains that are resistant to TMP SXT is increasing . The rate of resistance to TMP SXT ranges from 2% in Canada and Latin America to 10% in Europe
    Stenotrophomonas maltophilia resistant to trimethoprim sulphamethoxazole: an increasing problem

    Asma M Al-Jasser

    DR.T.V.RAO MD

    18

    MOLECULAR MECHANISMS OF RESISTANCE IN S.MALTOPHILIA


    S. maltophilia exhibits an array of mechanisms that singularly or collectively contribute to its multidrug
    resistance status. Intrinsic resistance includes inducible efflux pumps and multiple -lactamase expression but not mutations in the quinolone resistancedetermining region . In addition, S. maltophilia can acquire resistance through integrons, transposons, and plasmids . Recently, class 1 integrons have been characterized from S. maltophilia strains isolated in Argentina and Taiwan, which indicates that they contribute to TMP/SMX resistance through the sul1 gene carried as part of the 3 end of the class 1 integron

    DR.T.V.RAO MD

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    THERAPEUTIC FAILURES A GREAT CONCERN


    Therapy for these infections represents a significant challenge both for the clinician and the microbiologist because of this organism's high level of antibiotic resistance to most of the currently used agents and methodological difficulties in susceptibility testing with this organism

    DR.T.V.RAO MD

    20

    ROLE OF MICROBIOLOGY DEPARTMENTS


    The microbiology laboratory also plays a vital role in controlling S. maltophilia infections by continuous monitoring of the prevalence, the provision of local Antibiogram data and the performance of synergistic studies which may help to guide therapy selection.

    DR.T.V.RAO MD

    21

    CONTROLLING MALTOPHILIA INFECTIONS


    The proposed strategies to prevent S. maltophilia infection should be encouraged and they include: the avoidance of inappropriate use of antibiotics, the avoidance of prolonged implementation of foreign devices, the reinforcement of hand hygiene practices and the application of appropriate infection control 22 practices.

    DR.T.V.RAO MD

    EFFECTIVE HAND WASHING WILL REDUCE SEVERAL CASES OF NOSOCOMIAL INFECTIONS

    DR.T.V.RAO MD

    23

    FOR ARTICLES OF INTEREST ON INFECTIOUS DISEASES FOLLOW ME ON

    DR.T.V.RAO MD

    24

    REFERENCES
    1.Emerging Infectious diseases Volume 13, Number 4April 2007 2 American society of Microbiology 3 science photo library

    DR.T.V.RAO MD

    25

    Created by Dr.T.V.Rao MD for e learning resources for Microbiologists and Health care Workers in Developing World
    Email [email protected]

    DR.T.V.RAO MD

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