Tools
Stenotrophomonas Maltophilia
Introduction
Stenotrophomonas maltophilia is a gram-negative bacillus, initially called Bacterium bookeri, when it was first identified in 1943 from a specimen of human pleural fluid.[1] It was later classified as Pseudomonas maltophilia in 1961, then reassigned to the gammaproteobacteria class as Xanthomonas maltophilia in 1983, and eventually classified as a Stenotrophomonas in 199.[2][3][4] The name has Greek roots meaning “The narrow feeder - that loves malt.” The whole-genome sequence of representative isolate K279a genome sequence was published in 2008.[5][6]
S. maltophilia can be considered a “newly emerging pathogen of concern” that is being isolated more frequently.[7][8][9] It is also recognized as one of the underestimated important multi-drug resistant organisms in hospitals by the World Health Organization (WHO).[10][11] It was ranked as the ninth most important one per British microbiologists and one of the challenging pathogens in the infectious disease community and studies.[12][2] It is widely known as an opportunistic organism associated with high morbidity and mortality rates among immunocompromised patients.
Etiology
Register For Free And Read The Full Article
Search engine and full access to all medical articles- 10 free questions in your specialty
- Free CME/CE Activities
- Free daily question in your email
- Save favorite articles to your dashboard
- Emails offering discounts
Learn more about a Subscription to StatPearls Point-of-Care
Etiology
Stenotrophomonas maltophilia, a non-fermenting gram-negative rod, is the third most common after Pseudomonas aeruginosa and Acinetobacter and similar to Achromobacter xylosoxidans and Burkholderia cepacia.[13][4][9] It is the only species among the seventeen of the Stenotrophomonas genus that infects man.[14]
Risk factors for this infection include chronic respiratory diseases, especially cystic fibrosis, hematologic malignancy, chemotherapy-induced neutropenia, organ transplant patients, human immunodeficiency virus (HIV) infection, hemodialysis patients, and neonates.[9][11][15][16] Also, hospital settings, prolonged intensive care unit stays, mechanical ventilation, tracheostomies, central venous catheters, severe traumatic injuries, significant burns, mucositis or mucosal barrier damaging factors, and the use of broad-spectrum antibiotic courses were shown to increase the risk of infection.[9][17]
These empiric broad-spectrum antimicrobials usually do not cover this particular pathogen, especially carbapenems, although no specific predominance was identified with them over other antimicrobials.[18] The risk from antibiotic exposure varies directly with both the duration and number of antimicrobials used.[8]
Epidemiology
Stenotrophomonas maltophilia prevalent.[2] It is frequently isolated in the environment, particularly from water bodies like rivers, wells, and lakes, also bottled water, sewage, swine/chicken feces, soil, plants, salads, frozen fish, and raw milk.[2][8][17][19] It has also been isolated from animals, especially aquatic species, with some of those animal isolates found to be within the same genogroups as the human strains, suggesting the possibility of strain or gene exchange with the human infection-causing isolates.[9][20] Specific isolates are being utilized for the biosynthesis of organic compounds or their degradation, plant growth promotion against agricultural fungal pathogens, and bioremediation of soil or water.[21][6][22][23][24]
More importantly, it can be found in multiple healthcare settings, such as hospital tap water faucets, sinks, shower outlets, air-cooling systems, ice-making and soda fountain machines, disinfectant solutions, intravenous fluids, catheters, ethylenediaminetetraacetic acid (EDTA) containing blood collection tubes, blood gas analyzers, dialysis machines, intra-aortic balloon pumps, nebulizers, oxygen humidifiers, breathing circuits, scopes, dental equipment, lens care systems, and the hands of healthcare workers.[18][2][17][21][22][25]
Most Stenotrophomonas maltophilia infections are, in fact, nosocomial, and many outbreaks have been reported within the previous years in hospitals and intensive care units.[26][27][26] Studies have proven genomic diversity among nosocomial infection isolates, which strongly suggests multiple independent environmental sources of transmission, though the patient-to-patient transmission has also been reported.[28][29]
Stenotrophomonas maltophilia is estimated to be the most common carbapenem-resistant gram-negative bacterial cause of bloodstream infections in US hospitals, causing about 1% of nosocomial bacteremia cases.[30][31] The incidence of infection cases is estimated to be from 5.7 to 37.7 cases per 10 thousand hospital discharges, which has been progressively higher than previously reported over the last decades since the 1970s.[32][33][34][35][36] This rising infection rate is believed to be primarily due to the increase in the number of immunocompromised patients and the wide use of broad-spectrum antibiotics.
Pathophysiology
Although previously thought to have limited virulence, Stenotrophomonas maltophilia has shown to possess different powerful virulence factors that are believed to be present in all environmental isolates without any specific evolutionary branching, similar to Pseudomonas aeruginosa.[18][22][37]
The first noteworthy virulence factor is its ability to form a biofilm, which was demonstrated around 1996.[38] These biofilms consist of a polymeric matrix of polysaccharides, proteins, lipids, nucleic acids, and minimally active bacteria, which can become mature very rapidly, colonizing new surfaces within less than 24 hours.[11][38][39] The process starts with adherence to the surface, followed by irreversible attachment, then final maturation, and is mediated through its motile flagella, fimbriae/pili, adhesins, and the outer membrane lipopolysaccharide positively charged surface, quorum sensing by diffuse single molecules, and extracellular polymeric substances.[8][38] This biofilm allows Stenotrophomonas maltophilia to firmly adhere to both animate surfaces such as the respiratory epithelial tissue and inanimate surfaces such as ventilation tubes and circuits.[2][21][38] This enables it to escape the natural human phagocytosis and complement-mediated immune killing defenses, evade the activity of most antibiotics up to a thousand times more, and further spread throughout the surfaces.[8][3][26][38][39]
Often, the biofilms are polymicrobial and contain other organisms that benefit from the same advantages. The spgM gene was recognized to promote high biofilm production by isolates, along with several other genes.[38][40] Iron acquisition pathways through siderophore, heme-mediated, and Feo system uptake mechanisms play an essential role in regulating multiple virulence factors, including biofilm formation esp. on iron restriction.[41] Stenotrophomonas maltophilia in biofilms was also shown to tolerate a wide range of pH, nutrient scarcity, and exposure to free radicals.[21]
Second, Stenotrophomonas maltophilia is typically intrinsically resistant to multiple and broad-spectrum antibiotic agents.[42][43] It shows resistance to most beta-lactams through two inducible enzymes; the class B zinc-dependent penicillinase (L1) and the class A serine cephalosporinase (L2), rendering it resistant to ceftriaxone, piperacillin-tazobactam, and carbapenems.[4][18] Clavulanic acid has shown activity against the L2 enzyme but not L1.[9] It also confers resistance to aminoglycosides by its aminoglycoside-modifying acetyl-transferase enzyme.[4] Several other antimicrobial resistances are achieved through the efflux pumps (for example, the SmeDEF and SmeABC) that act on quinolones, aminoglycosides, macrolides, and tetracyclines.[4][18][42][44]
Trimethoprim-sulfamethoxazole resistance is mediated through the target site modification genes sul1 and dfrA through class 1 integrons, as well as sul2 gene through insertion sequence common region elements.[8][9] Another mechanism involves the gyrase and topoisomerase targets of quinolones.[4][45] Lastly, its outer-membrane lipopolysaccharide shows temperature-dependent structural variation, which confers more resistance to aminoglycosides and polymyxins in particular.[2] Interestingly, Stenotrophomonas maltophilia can both acquire and transfer antibiotic and heavy metal resistance mechanisms with other pathogens if they co-exist, such as the transfer of the beta-lactamases to previously susceptible Pseudomonas isolates.[2][17][46][47] This process is referred to as “indirect pathogenicity” and is mediated through integrons, transposons, plasmids, genomic islands, and others.[8][48]
Third, Stenotrophomonas maltophilia utilizes different virulence exoenzymes, such as elastase, gelatinase, hyaluronidase, proteases, lipases, DNase, RNase, and mucinase, for tissue invasion and escaping the host immunity.[18] Lipases, in particular, are also believed to damage the lipid-rich lung tissues leading to focal lung necrosis and initiating strong inflammatory responses.[2]
Fourth, in chronic infections, Stenotrophomonas maltophilia is capable of forming small-colony variants, which are slowly growing and sometimes challenging to detect.[49]
History and Physical
Stenotrophomonas maltophilia infections usually occur as a nosocomial infection, though community-acquired infections have also been reported.[50] One of the challenges with Stenotrophomonas maltophilia is that its clinical manifestations are non-specific and almost cannot be distinguished from other infections. As mentioned above, it is, therefore, essential to identify the most vulnerable population to such infection, most importantly the immunocompromised population.[51] However, one characteristic feature is the late-onset of the related illnesses, which can be about 5 days for hospital-acquired pneumonia and 19 days for bacteremia.[52][50]
It is crucial to differentiate between non-invasive colonization from non-sterile samples and an actual infection that warrants treatment, mainly by the clinical judgment on the symptoms, signs, laboratory, and radiographic evidence of infection.
The most common isolates were reported from respiratory infections, namely pneumonia cases, whether sputum or bronchioalveolar lavage cultures, at 55% of the total infections.[53][38] Many times, as mentioned above, it occurs in patients with cystic fibrosis with almost 15% colonization prevalence, tracheostomy patients, or those on mechanical ventilation.[9] It was also implicated in cases of chronic obstructive pulmonary disease exacerbations.[54] In certain situations, especially with underlying hematologic malignancies, a fatal fulminant hemorrhagic pneumonia syndrome can occur.[55][9] Sinopulmonary infections, particularly in neutropenic patients, can raise suspicion for this infection as well.[18]
The second most common form of Stenotrophomonas maltophilia infections is bacteremia, at 33% of the infections.[38] Sometimes the bacteremia is polymicrobial, especially along with Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterococcus faecalis.[9][56] More than 70% of the reported cases were deemed to be central venous catheter-related infections. Recurrence has also been encountered in cases of retained central venous catheters or delayed targeted antibiotics [57].
There have been less commonly reported cases of other sites of infection, such as skin and soft tissue infections, at 7.8% of the total infections, most notably wound infections, metastatic cellulitis, and ecthyma gangrenosum.[58] Others, in no particular order, include meningitis (mostly post-surgery), ocular infections, especially after surface compromise (keratitis, conjunctivitis, endophthalmitis, dacryocystitis, scleral buckle infections, preseptal cellulitis, orbital necrotizing fasciitis, etc.), gingivitis, periodontitis, epiglottitis, sinusitis, otitis externa, mastoiditis, endocarditis, pacemaker infections, intra-abdominal infections (peritonitis, cholangitis, abscesses, enteritis, etc.), urinary tract infections (especially with catheterization and structural abnormalities), epididymitis, septic arthritis, osteochondritis, and bursitis.[9][18][59][2][8][60][17][61]
Evaluation
Stenotrophomonas maltophilia easily grows on standard culture media, either as a single isolate or mixed with other culture growths like Pseudomonas aeruginosa.[53] Its culture colonies typically are yellow-green in color on nutrient agar, non-hemolytic with a faint lavender color and an ammonia odor on blood agar, and colorless on MacConkey plates since it is non-lactose fermenting.[18][17][21] It also resembles Pseudomonas in having opaque flat surfaces with uneven borders. Selective media were shown to be better in isolating Stenotrophomonas maltophilia from non-sterile samples and usually contain imipenem, vancomycin, amphotericin-B, and mannitol/bromothymol blue as an indicator.[2][62][3]
For in vitro laboratory identification, Stenotrophomonas maltophilia is a strict aerobe that is usually oxidase negative, though it was shown that up to 20% could show positive oxidase activity.[17][63] It is also catalase-positive, DNase-positive, lysine decarboxylase positive, indole negative, HS negative, and urease negative.[4][9] It is known to produce acid from maltose, hence the name maltophilia, but not always from glucose. Many commercial systems are available for identification but are not very accurate.[2] Therefore, it has been misdiagnosed as Burkholderia cepacia-complex, Achromobacter xylosoxidans, Pseudomonas aeruginosa, and Bordetella bronchiseptica an identification challenge.
Another diagnostic challenge involves antibiotic susceptibility testing due to difficulties in setting standard minimal inhibitory concentration (MIC) breakpoints for Stenotrophomonas maltophilia through different methods.[2] However, currently, in the U.S., the Clinical and Laboratory Standards Institute (CSLI) has set MICs for trimethoprim-sulfamethoxazole (2 mg/L), levofloxacin, and minocycline by the disc diffusion method, as well as for levofloxacin, ticarcillin-clavulanate, minocycline, ceftazidime, and chloramphenicol by the broth dilution method. Other agents in studies, even in the same classes of these antimicrobials, do not have established breakpoints yet.[64]
Nucleic-acid amplification testing (NAAT) and species-specific 23S rRNA-directed polymerase chain reaction (PCR) techniques are also well used for identification successfully with almost 100% sensitivity and specificity when available.[65][66] The matrix-assisted laser desorption ionization, time of flight (MALDI-TOF) mass spectrometry has shown good identification as well, in addition to its potential ability to recognize biofilm-producing strains.[67][29] The use of these rapid methods on samples from critically ill patients can facilitate more rapid use of appropriate antibiotics.[9]
Chest x-rays may reveal lobar or lobular infiltrates in pneumonia cases, either unilateral or bilateral, with uncommon pleural effusions or cavitary lesions on rare occasions.[68]
Treatment / Management
Treatment with specific antibiotics is required when evidence for a true Stenotrophomonas maltophilia infection is established or in critically sick patients with a Stenotrophomonas maltophilia growth until further data are available. Treatment recommendations mostly come from in vitro studies, retrospective studies, non-randomized clinical trials, and expert opinions.[64](B3)
The first-line treatment is trimethoprim-sulfamethoxazole, which has been the recommended empiric single agent against Stenotrophomonas maltophilia for many years.[17][69] Given the in vitro data suggesting bacteriostatic activity against Stenotrophomonas maltophilia, trimethoprim-sulfamethoxazole is recommended at high doses at 15 mg/kg or more of the trimethoprim component, as used for severe Pneumocystis jirovecii pneumonia.[9][70] It has shown activity against more than 90% of the tested isolates in most studies to date, though as mentioned above, resistance has now been increasingly reported at up to 22-38% in some 21st-century studies.[71][72][69][73][74] (B2)
One recent study from Mexico showed an 80% resistance rate to trimethoprim/sulfamethoxazole in a combination of environmental and clinical isolates from Mexico.[75] Also, since trimethoprim-sulfamethoxazole has risks of hypersensitivity, hyperkalemia, deterioration of kidney functions, and bone marrow suppression, those with either a contraindication, intolerance, or adverse events to it must subsequently be treated with another alternative agent, unless there is a chance and benefit from an oral desensitization trial.[76](B3)
Alternatives treatments are the bacteriocidal fluoroquinolones, with up to 80-90% susceptibility rates, because of their specific biofilm active properties and their high concentration in the lungs.[9][4][77][39][17][69][78] These include levofloxacin, moxifloxacin, and the newer agents clinafloxacin and rufloxacin (which both showed even better activity than the others), also gatifloxacin, travofloxacin, grepafloxacin, and sparfloxacin.[79][80][77] Some new studies observed fluoroquinolones susceptibilities down to 73% [81][82][69]. Overall, several studies demonstrated equal effectiveness to trimethoprim/sulfamethoxazole with better fluoroquinolones adverse effects profile.[83][84](B2)
For second-line treatments, minocycline and tigecycline have been reported to have good effectiveness against many isolates at around 80% to 100% susceptibility rate even for isolates resistant to trimethoprim-sulfamethoxazole.[85][86][87][88] Further, ticarcillin-clavulanic acid has been well studied as one of the effective treatment options for Stenotrophomonas maltophilia infections [17], with a susceptibility rate ranging from below 50% sometimes to above 80%.[64][89] Other options include ceftazidime, though some bodies report it as intrinsically resistant and with increasing resistance. Next, colistin is considered a good option at about a 72% to 77% susceptibility rate.[90] Another uncommonly used but effective agent is chloramphenicol, with a wide range of susceptibility reports.[17][22](B2)
Resistance to many of these antimicrobials and the co-existence of multiple resistances together are being reported at higher rates in the literature, which creates the need for new agents and regimens to be utilized.[69][91] Sulfametrole/trimethoprim is an alternative combination to trimethoprim/sulfamethoxazole that was tested and showed good activity in some studies.[92] Cefiderocol is a new injectable siderophore cephalosporin that has shown promising data against carbapenem-resistant gram-negative bacteria, including Stenotrophomonas maltophilia.[93][94][95] (B2)
Eravacycline, omadacycline, and delafloxacin have demonstrated good in-vitro activity as well for their respective infection indications.[69][96][97] On the other hand, several new antimicrobials like ceftazidime/avibactam, ceftolozane/tazobactam, meropenem/vaborbactam, cilastatin/relebactam, plazomicin, and fosfomycin did not show activity against Stenotrophomonas maltophilia in recent reports.[98] Combinations of antimicrobials have been studied with good synergistic promising results, including trimethoprim-sulfamethoxazole/ciprofloxacin, ceftazidime/levofloxacin, ticarcillin-clavulanate/trimethoprim-sulfamethoxazole, ticarcillin-clavulanate/aztreonam, tigecycline/colistin, colistin/rifampicin, ceftazidime/minocycline, levofloxacin/erythromycin, and tigecycline/fosfomycin.[99][100][101][102](B3)
Since some isolates showed resistance to all known tested antimicrobials, new treatment approaches and modalities are currently being studied, such as aerosolized antimicrobials (colistin and levofloxacin), bacteriophage therapy, efflux pump inhibitors, quorum sensing interference (quorum quenching), antimicrobial peptides like the cathelicidin-derived ones, silver or selenium nanoparticles, cationic compounds, plant oils, green tea epigallocatechin-3-gallate, and using Bdellovivrio exovorus as a bacterial predator.[103][104][105](A1)
The typical duration of antimicrobial courses for Stenotrophomonas maltophilia pneumonia is usually 7 days, which can be extended to 10 to 14 days in immunosuppressed patients. Bacteremia cases, on the other hand, are generally treated for 14 days total.
Source control is essential in certain cases for successful treatment, such as central venous catheter removal, infected metal hardware retrieval, wounds debridement, conjunctival autografting, and collections drainage.[50][59](B2)
Differential Diagnosis
- Other Stenotrophomonas species typically do not cause infections in humans.
- Other gram-negative non-fermenters like Pseudomonas aeruginosa, Acinetobacter baumannii, Achromobacter xylosoxidans, and Burkholderia cepacia-complex, can be misidentified as, co-exist with, or be responsible for similar infections to Stenotrophomonas maltophilia.
- Other more common organisms should be considered first with each infection according to the clinical picture.
Prognosis
There have been controversial data about the high mortality associations with Stenotrophomonas maltophilia. The crude mortality rate is estimated to be around 14% to 69% of cases.[106][107] According to a systematic review, the attributable mortality rate of all Stenotrophomonas maltophilia infections was up to 37.5%.[108] The reported attributable mortality rate in pneumonia cases was at least 20%, while in bacteremia cases was 27%, which was within the same range as other causes of nosocomial bacteremia.[109][18]
It was also shown that colonization with Stenotrophomonas maltophilia in patients undergoing allogeneic hematopoietic stem cell transplants was associated with significantly higher non-relapse mortality, mainly secondary to severe infections.[110]
Complications
Stenotrophomonas maltophilia outbreaks can occur in hospitals and critical care units.[27] Biofilm formation leads to the persistence of the bacteria in hospital settings and on equipment.[38]
Infections with Stenotrophomonas maltophilia have been associated with worsening lung functions in cystic fibrosis patients.[6][111] Severe fulminant lung infections can occur in cases of hematologic malignancies.[55]
Bacteremia cases can be complicated by disseminated intravascular coagulopathy (DIC) and purpura fulminans in severe cases.[18] Recurrence of bacteremia infections occurs when related central venous catheters are not removed or in cases of inappropriate antibiotics.[57]
The aforementioned complications, morbidities, and mortalities, and economic burden highlight the importance of infection prevention.
Deterrence and Patient Education
Stenotrophomonas maltophilia is an intrinsically multidrug-resistant bacteria that usually infects patients with weak immunity. It is often uneasy about treating, given the limited options of antibiotics that can work against it. Always seek your physician’s help to answer any questions about this infection since information about it is not readily available to the public. Patients should mention to their provider if they have allergies to the antibiotic co-trimoxazole since it is usually involved in the treatment.
Enhancing Healthcare Team Outcomes
All interprofessional healthcare team members need to have good communication regarding the treatment plan for Stenotrophomonas maltophilia. This includes the clinicians (including mid-level practitioners), residents, infectious diseases consultants, nurses, pharmacists, and the infection prevention team. By coordinating treatment efforts and sharing information about the case, patient outcomes will be improved with fewer adverse events. [Level 5]
Antibiotic stewardship programs are also critical in preventing and treating Stenotrophomonas maltophilia infections by limiting the unnecessary use of broad-spectrum empiric antimicrobials to the minimum.
Strict infection prevention measures are also to be implemented and stressed to all team members, including hand hygiene, central venous line insertion precautions, appropriate disposal of potentially contaminated solutions, and proper handling and disinfection of medical equipment.[9][8][17] Using disinfectants like 3% hydrogen peroxide and 10% peracetic acid has shown to be effective.[112]
Environmental sampling, especially in outbreak situations, is important to identify potential sources. Maintenance of the water supplies, water filtration, and copper-silver ionization for plumbing systems disinfection is recommended to limit the transmission.[9][8][17] Utilizing new adhesion-resistant materials in medical supplies when made available can also show a positive effect.[2]
References
Palleroni NJ, Bradbury JF. Stenotrophomonas, a new bacterial genus for Xanthomonas maltophilia (Hugh 1980) Swings et al. 1983. International journal of systematic bacteriology. 1993 Jul:43(3):606-9 [PubMed PMID: 8347518]
Level 1 (high-level) evidenceLooney WJ. Role of Stenotrophomonas maltophilia in hospital-acquired infection. British journal of biomedical science. 2005:62(3):145-54; quiz 1 p following 154 [PubMed PMID: 16196464]
Pinot C, Deredjian A, Nazaret S, Brothier E, Cournoyer B, Segonds C, Favre-Bonté S. Identification of Stenotrophomonas maltophilia strains isolated from environmental and clinical samples: a rapid and efficient procedure. Journal of applied microbiology. 2011 Nov:111(5):1185-93. doi: 10.1111/j.1365-2672.2011.05120.x. Epub 2011 Aug 30 [PubMed PMID: 21819497]
Abbott IJ, Peleg AY. Stenotrophomonas, Achromobacter, and nonmelioid Burkholderia species: antimicrobial resistance and therapeutic strategies. Seminars in respiratory and critical care medicine. 2015 Feb:36(1):99-110. doi: 10.1055/s-0034-1396929. Epub 2015 Feb 2 [PubMed PMID: 25643274]
Crossman LC, Gould VC, Dow JM, Vernikos GS, Okazaki A, Sebaihia M, Saunders D, Arrowsmith C, Carver T, Peters N, Adlem E, Kerhornou A, Lord A, Murphy L, Seeger K, Squares R, Rutter S, Quail MA, Rajandream MA, Harris D, Churcher C, Bentley SD, Parkhill J, Thomson NR, Avison MB. The complete genome, comparative and functional analysis of Stenotrophomonas maltophilia reveals an organism heavily shielded by drug resistance determinants. Genome biology. 2008 Apr 17:9(4):R74. doi: 10.1186/gb-2008-9-4-r74. Epub 2008 Apr 17 [PubMed PMID: 18419807]
Level 2 (mid-level) evidenceAn SQ, Berg G. Stenotrophomonas maltophilia. Trends in microbiology. 2018 Jul:26(7):637-638. doi: 10.1016/j.tim.2018.04.006. Epub 2018 May 10 [PubMed PMID: 29754971]
Johnson AP, Duckworth GJ. The emergence of Stenotrophomonas maltophilia. BMJ (Clinical research ed.). 2008 Jun 14:336(7657):1322. doi: 10.1136/bmj.a226. Epub [PubMed PMID: 18556278]
Looney WJ, Narita M, Mühlemann K. Stenotrophomonas maltophilia: an emerging opportunist human pathogen. The Lancet. Infectious diseases. 2009 May:9(5):312-23. doi: 10.1016/S1473-3099(09)70083-0. Epub [PubMed PMID: 19393961]
Abbott IJ, Slavin MA, Turnidge JD, Thursky KA, Worth LJ. Stenotrophomonas maltophilia: emerging disease patterns and challenges for treatment. Expert review of anti-infective therapy. 2011 Apr:9(4):471-88. doi: 10.1586/eri.11.24. Epub [PubMed PMID: 21504403]
Level 3 (low-level) evidenceBrooke JS. New strategies against Stenotrophomonas maltophilia: a serious worldwide intrinsically drug-resistant opportunistic pathogen. Expert review of anti-infective therapy. 2014 Jan:12(1):1-4. doi: 10.1586/14787210.2014.864553. Epub 2013 Dec 4 [PubMed PMID: 24308713]
Willsey GG, Eckstrom K, LaBauve AE, Hinkel LA, Schutz K, Meagher RJ, LiPuma JJ, Wargo MJ. Stenotrophomonas maltophilia Differential Gene Expression in Synthetic Cystic Fibrosis Sputum Reveals Shared and Cystic Fibrosis Strain-Specific Responses to the Sputum Environment. Journal of bacteriology. 2019 Aug 1:201(15):. doi: 10.1128/JB.00074-19. Epub 2019 Jul 10 [PubMed PMID: 31109991]
Bywater RJ, Casewell MW. An assessment of the impact of antibiotic resistance in different bacterial species and of the contribution of animal sources to resistance in human infections. The Journal of antimicrobial chemotherapy. 2000 Dec:46(6):1052 [PubMed PMID: 11102436]
Level 3 (low-level) evidenceSader HS, Jones RN. Antimicrobial susceptibility of uncommonly isolated non-enteric Gram-negative bacilli. International journal of antimicrobial agents. 2005 Feb:25(2):95-109 [PubMed PMID: 15664479]
Coenye T, Vanlaere E, Falsen E, Vandamme P. Stenotrophomonas africana Drancourt et al. 1997 is a later synonym of Stenotrophomonas maltophilia (Hugh 1981) Palleroni and Bradbury 1993. International journal of systematic and evolutionary microbiology. 2004 Jul:54(Pt 4):1235-1237. doi: 10.1099/ijs.0.63093-0. Epub [PubMed PMID: 15280297]
Level 1 (high-level) evidencePaez JI, Tengan FM, Barone AA, Levin AS, Costa SF. Factors associated with mortality in patients with bloodstream infection and pneumonia due to Stenotrophomonas maltophilia. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2008 Oct:27(10):901-6. doi: 10.1007/s10096-008-0518-2. Epub 2008 May 16 [PubMed PMID: 18483755]
Level 2 (mid-level) evidenceKwa AL, Low JG, Lim TP, Leow PC, Kurup A, Tam VH. Independent predictors for mortality in patients with positive Stenotrophomonas maltophilia cultures. Annals of the Academy of Medicine, Singapore. 2008 Oct:37(10):826-30 [PubMed PMID: 19037515]
Level 2 (mid-level) evidenceBrooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clinical microbiology reviews. 2012 Jan:25(1):2-41. doi: 10.1128/CMR.00019-11. Epub [PubMed PMID: 22232370]
Senol E. Stenotrophomonas maltophilia: the significance and role as a nosocomial pathogen. The Journal of hospital infection. 2004 May:57(1):1-7 [PubMed PMID: 15142709]
Chien YC, Chen CJ, Lin TH, Chen SH, Chien YC. Characteristics of microbial aerosols released from chicken and swine feces. Journal of the Air & Waste Management Association (1995). 2011 Aug:61(8):882-9 [PubMed PMID: 21874960]
Level 3 (low-level) evidenceJayol A, Corlouer C, Haenni M, Darty M, Maillard K, Desroches M, Lamy B, Jumas-Bilak E, Madec JY, Decousser JW. Are animals a source of Stenotrophomonas maltophilia in human infections? Contributions of a nationwide molecular study. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2018 Jun:37(6):1039-1045. doi: 10.1007/s10096-018-3203-0. Epub 2018 Feb 27 [PubMed PMID: 29488120]
Level 3 (low-level) evidenceMahdi O, Eklund B, Fisher N. Laboratory culture and maintenance of Stenotrophomonas maltophilia. Current protocols in microbiology. 2014 Feb 6:32():Unit 6F.1.. doi: 10.1002/9780471729259.mc06f01s32. Epub 2014 Feb 6 [PubMed PMID: 24510848]
Geiger AM, Hogardt M, Heesemann J. Burkholderia/Stenotrophomonas. Contributions to microbiology. 2001:8():20-34 [PubMed PMID: 11764736]
Mukherjee P, Roy P. Genomic Potential of Stenotrophomonas maltophilia in Bioremediation with an Assessment of Its Multifaceted Role in Our Environment. Frontiers in microbiology. 2016:7():967. doi: 10.3389/fmicb.2016.00967. Epub 2016 Jun 22 [PubMed PMID: 27446008]
Allen MJ, Tait K, Mühling M, Weynberg K, Bradley C, Trivedi U, Gharbi K, Nissimov J, Mavromatis K, Jensen CN, Grogan G, Ali ST. Genome sequence of Stenotrophomonas maltophilia PML168, which displays Baeyer-Villiger monooxygenase activity. Journal of bacteriology. 2012 Sep:194(17):4753-4. doi: 10.1128/JB.00949-12. Epub [PubMed PMID: 22887661]
Weber DJ, Rutala WA, Blanchet CN, Jordan M, Gergen MF. Faucet aerators: A source of patient colonization with Stenotrophomonas maltophilia. American journal of infection control. 1999 Feb:27(1):59-63 [PubMed PMID: 9949380]
Guyot A, Turton JF, Garner D. Outbreak of Stenotrophomonas maltophilia on an intensive care unit. The Journal of hospital infection. 2013 Dec:85(4):303-7. doi: 10.1016/j.jhin.2013.09.007. Epub 2013 Oct 2 [PubMed PMID: 24148363]
Alfieri N, Ramotar K, Armstrong P, Spornitz ME, Ross G, Winnick J, Cook DR. Two consecutive outbreaks of Stenotrophomonas maltophilia (Xanthomonas maltophilia) in an intensive-care unit defined by restriction fragment-length polymorphism typing. Infection control and hospital epidemiology. 1999 Aug:20(8):553-6 [PubMed PMID: 10466556]
Barchitta M, Cipresso R, Giaquinta L, Romeo MA, Denaro C, Pennisi C, Agodi A. Acquisition and spread of Acinetobacter baumannii and Stenotrophomonas maltophilia in intensive care patients. International journal of hygiene and environmental health. 2009 May:212(3):330-7. doi: 10.1016/j.ijheh.2008.07.001. Epub 2008 Sep 3 [PubMed PMID: 18771951]
Level 2 (mid-level) evidenceMontoya-Hinojosa E, Bocanegra-Ibarias P, Garza-González E, Alonso-Ambriz ÓM, Salazar-Mata GA, Villarreal-Treviño L, Pérez-Alba E, Camacho-Ortiz A, Morfín-Otero R, Rodríguez-Noriega E, Flores-Treviño S. Discrimination of biofilm-producing Stenotrophomonas maltophilia clinical strains by matrix-assisted laser desorption ionization-time of flight. PloS one. 2020:15(12):e0244751. doi: 10.1371/journal.pone.0244751. Epub 2020 Dec 31 [PubMed PMID: 33382839]
Ryan RP, Monchy S, Cardinale M, Taghavi S, Crossman L, Avison MB, Berg G, van der Lelie D, Dow JM. The versatility and adaptation of bacteria from the genus Stenotrophomonas. Nature reviews. Microbiology. 2009 Jul:7(7):514-25. doi: 10.1038/nrmicro2163. Epub [PubMed PMID: 19528958]
Biagi M, Tan X, Wu T, Jurkovic M, Vialichka A, Meyer K, Mendes RE, Wenzler E. Activity of Potential Alternative Treatment Agents for Stenotrophomonas maltophilia Isolates Nonsusceptible to Levofloxacin and/or Trimethoprim-Sulfamethoxazole. Journal of clinical microbiology. 2020 Jan 28:58(2):. doi: 10.1128/JCM.01603-19. Epub 2020 Jan 28 [PubMed PMID: 31748318]
Denton M, Kerr KG. Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia. Clinical microbiology reviews. 1998 Jan:11(1):57-80 [PubMed PMID: 9457429]
Morrison AJ Jr, Hoffmann KK, Wenzel RP. Associated mortality and clinical characteristics of nosocomial Pseudomonas maltophilia in a university hospital. Journal of clinical microbiology. 1986 Jul:24(1):52-5 [PubMed PMID: 3487553]
del Toro MD, Rodríguez-Bano J, Herrero M, Rivero A, García-Ordoñez MA, Corzo J, Pérez-Cano R, Grupo Andaluz para el Estudio de las Enfermedades Infecciosas. Clinical epidemiology of Stenotrophomonas maltophilia colonization and infection: a multicenter study. Medicine. 2002 May:81(3):228-39 [PubMed PMID: 11997719]
Level 2 (mid-level) evidenceFalagas ME, Valkimadi PE, Huang YT, Matthaiou DK, Hsueh PR. Therapeutic options for Stenotrophomonas maltophilia infections beyond co-trimoxazole: a systematic review. The Journal of antimicrobial chemotherapy. 2008 Nov:62(5):889-94. doi: 10.1093/jac/dkn301. Epub 2008 Jul 28 [PubMed PMID: 18662945]
Level 1 (high-level) evidencePatterson SB, Mende K, Li P, Lu D, Carson ML, Murray CK, Tribble DR, Blyth DM, IDCRP TIDOS Group. Stenotrophomonas maltophilia infections: Clinical characteristics in a military trauma population. Diagnostic microbiology and infectious disease. 2020 Feb:96(2):114953. doi: 10.1016/j.diagmicrobio.2019.114953. Epub 2019 Nov 23 [PubMed PMID: 31791809]
Lira F, Berg G, Martínez JL. Double-Face Meets the Bacterial World: The Opportunistic Pathogen Stenotrophomonas maltophilia. Frontiers in microbiology. 2017:8():2190. doi: 10.3389/fmicb.2017.02190. Epub 2017 Nov 9 [PubMed PMID: 29170656]
Flores-Treviño S, Bocanegra-Ibarias P, Camacho-Ortiz A, Morfín-Otero R, Salazar-Sesatty HA, Garza-González E. Stenotrophomonas maltophilia biofilm: its role in infectious diseases. Expert review of anti-infective therapy. 2019 Nov:17(11):877-893. doi: 10.1080/14787210.2019.1685875. Epub 2019 Nov 1 [PubMed PMID: 31658838]
Sun E, Liang G, Wang L, Wei W, Lei M, Song S, Han R, Wang Y, Qi W. Antimicrobial susceptibility of hospital acquired Stenotrophomonas maltophilia isolate biofilms. The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases. 2016 Jul-Aug:20(4):365-73. doi: 10.1016/j.bjid.2016.04.002. Epub 2016 May 13 [PubMed PMID: 27183359]
Level 2 (mid-level) evidencePompilio A, Pomponio S, Crocetta V, Gherardi G, Verginelli F, Fiscarelli E, Dicuonzo G, Savini V, D'Antonio D, Di Bonaventura G. Phenotypic and genotypic characterization of Stenotrophomonas maltophilia isolates from patients with cystic fibrosis: genome diversity, biofilm formation, and virulence. BMC microbiology. 2011 Jul 5:11():159. doi: 10.1186/1471-2180-11-159. Epub 2011 Jul 5 [PubMed PMID: 21729271]
Level 3 (low-level) evidenceKalidasan V, Joseph N, Kumar S, Awang Hamat R, Neela VK. Iron and Virulence in Stenotrophomonas Maltophilia: All We Know So Far. Frontiers in cellular and infection microbiology. 2018:8():401. doi: 10.3389/fcimb.2018.00401. Epub 2018 Nov 12 [PubMed PMID: 30483485]
Blanco P, Corona F, Martinez JL. Mechanisms and phenotypic consequences of acquisition of tigecycline resistance by Stenotrophomonas maltophilia. The Journal of antimicrobial chemotherapy. 2019 Nov 1:74(11):3221-3230. doi: 10.1093/jac/dkz326. Epub [PubMed PMID: 31369109]
Sánchez MB. Antibiotic resistance in the opportunistic pathogen Stenotrophomonas maltophilia. Frontiers in microbiology. 2015:6():658. doi: 10.3389/fmicb.2015.00658. Epub 2015 Jun 30 [PubMed PMID: 26175724]
Shah S, King M, Rose L. Medical Management of Endocarditis Caused by Stenotrophomonas maltophilia: A Case Report. Journal of pharmacy practice. 2019 Dec:32(6):683-686. doi: 10.1177/0897190018764957. Epub 2018 Mar 25 [PubMed PMID: 29575970]
Level 3 (low-level) evidenceSánchez MB, Martínez JL. SmQnr contributes to intrinsic resistance to quinolones in Stenotrophomonas maltophilia. Antimicrobial agents and chemotherapy. 2010 Jan:54(1):580-1. doi: 10.1128/AAC.00496-09. Epub 2009 Oct 19 [PubMed PMID: 19841154]
Level 3 (low-level) evidenceAlonso A, Sanchez P, Martínez JL. Stenotrophomonas maltophilia D457R contains a cluster of genes from gram-positive bacteria involved in antibiotic and heavy metal resistance. Antimicrobial agents and chemotherapy. 2000 Jul:44(7):1778-82 [PubMed PMID: 10858330]
Babálová M, Blahová J, Lesická-Hupková M, Krcméry V Sr, Kubonová K. Transfer of ceftazidime and aztreonam resistance from nosocomial strains of Xanthomonas (Stenotrophomonas) maltophilia to a recipient strain of Pseudomonas aeruginosa ML-1008. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 1995 Oct:14(10):925-7 [PubMed PMID: 8605913]
Level 3 (low-level) evidenceWang Y,He T,Shen Z,Wu C, Antimicrobial Resistance in {i}Stenotrophomonas{/i} spp. Microbiology spectrum. 2018 Jan [PubMed PMID: 29350131]
Anderson SW, Stapp JR, Burns JL, Qin X. Characterization of small-colony-variant Stenotrophomonas maltophilia isolated from the sputum specimens of five patients with cystic fibrosis. Journal of clinical microbiology. 2007 Feb:45(2):529-35 [PubMed PMID: 17135443]
Level 2 (mid-level) evidenceFriedman ND, Korman TM, Fairley CK, Franklin JC, Spelman DW. Bacteraemia due to Stenotrophomonas maltophilia: an analysis of 45 episodes. The Journal of infection. 2002 Jul:45(1):47-53 [PubMed PMID: 12217732]
Level 2 (mid-level) evidenceHanberger H, Diekema D, Fluit A, Jones R, Struelens M, Spencer R, Wolff M. Surveillance of antibiotic resistance in European ICUs. The Journal of hospital infection. 2001 Jul:48(3):161-76 [PubMed PMID: 11439002]
Mehta RM, Niederman MS. Nosocomial pneumonia in the intensive care unit: controversies and dilemmas. Journal of intensive care medicine. 2003 Jul-Aug:18(4):175-88 [PubMed PMID: 15035764]
Kataoka D, Fujiwara H, Kawakami T, Tanaka Y, Tanimoto A, Ikawa S, Tanaka Y. The indirect pathogenicity of Stenotrophomonas maltophilia. International journal of antimicrobial agents. 2003 Dec:22(6):601-6 [PubMed PMID: 14659658]
Nseir S, Di Pompeo C, Cavestri B, Jozefowicz E, Nyunga M, Soubrier S, Roussel-Delvallez M, Saulnier F, Mathieu D, Durocher A. Multiple-drug-resistant bacteria in patients with severe acute exacerbation of chronic obstructive pulmonary disease: Prevalence, risk factors, and outcome. Critical care medicine. 2006 Dec:34(12):2959-66 [PubMed PMID: 17012911]
Level 2 (mid-level) evidenceOrtín X, Jaen-Martinez J, Rodríguez-Luaces M, Alvaro T, Font L. Fatal pulmonary hemorrhage in a patient with myelodysplastic syndrome and fulminant pneumonia caused by Stenotrophomonas maltophilia. Infection. 2007 Jun:35(3):201-2 [PubMed PMID: 17565466]
Level 3 (low-level) evidenceYeshurun M, Gafter-Gvili A, Thaler M, Keller N, Nagler A, Shimoni A. Clinical characteristics of Stenotrophomonas maltophilia infection in hematopoietic stem cell transplantation recipients: a single center experience. Infection. 2010 Jun:38(3):211-5. doi: 10.1007/s15010-010-0023-2. Epub 2010 Apr 28 [PubMed PMID: 20425134]
Level 2 (mid-level) evidenceLai CH, Wong WW, Chin C, Huang CK, Lin HH, Chen WF, Yu KW, Liu CY. Central venous catheter-related Stenotrophomonas maltophilia bacteraemia and associated relapsing bacteraemia in haematology and oncology patients. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2006 Oct:12(10):986-91 [PubMed PMID: 16961635]
Chang YT, Lin CY, Chen YH, Hsueh PR. Update on infections caused by Stenotrophomonas maltophilia with particular attention to resistance mechanisms and therapeutic options. Frontiers in microbiology. 2015:6():893. doi: 10.3389/fmicb.2015.00893. Epub 2015 Sep 2 [PubMed PMID: 26388847]
Chen YF, Chung PC, Hsiao CH. Stenotrophomonas maltophilia keratitis and scleritis. Chang Gung medical journal. 2005 Mar:28(3):142-50 [PubMed PMID: 15945320]
Level 3 (low-level) evidenceWladis EJ. Dacryocystitis secondary to Stenotrophomonas maltophilia infection. Ophthalmic plastic and reconstructive surgery. 2011 Sep-Oct:27(5):e116-7. doi: 10.1097/IOP.0b013e318201ca3b. Epub [PubMed PMID: 21178795]
Level 3 (low-level) evidenceKaran NB, Kose R, Kalyoncu A, Sekeryapan B, Oter K, Findik H, Yurdakul C. Fatal orbital necrotizing fasciitis secondary to stenotrophomonas maltophilia associated stomatitis. Journal of stomatology, oral and maxillofacial surgery. 2019 Jun:120(3):260-262. doi: 10.1016/j.jormas.2018.11.004. Epub 2018 Nov 19 [PubMed PMID: 30465891]
Denton M, Hall MJ, Todd NJ, Kerr KG, Littlewood JM. Improved isolation of Stenotrophomonas maltophilia from the sputa of patients with cystic fibrosis using a selective medium. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2000 Jul:6(7):397-8 [PubMed PMID: 11168159]
Carmody LA, Spilker T, LiPuma JJ. Reassessment of Stenotrophomonas maltophilia phenotype. Journal of clinical microbiology. 2011 Mar:49(3):1101-3. doi: 10.1128/JCM.02204-10. Epub 2010 Dec 29 [PubMed PMID: 21191048]
Nicodemo AC, Paez JI. Antimicrobial therapy for Stenotrophomonas maltophilia infections. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2007 Apr:26(4):229-37 [PubMed PMID: 17334747]
Level 3 (low-level) evidenceWhitby PW, Carter KB, Burns JL, Royall JA, LiPuma JJ, Stull TL. Identification and detection of Stenotrophomonas maltophilia by rRNA-directed PCR. Journal of clinical microbiology. 2000 Dec:38(12):4305-9 [PubMed PMID: 11101555]
Gallo SW, Ramos PL, Ferreira CA, Oliveira SD. A specific polymerase chain reaction method to identify Stenotrophomonas maltophilia. Memorias do Instituto Oswaldo Cruz. 2013 May:108(3):390-1. doi: 10.1590/S0074-02762013000300020. Epub [PubMed PMID: 23778655]
Clark AE, Kaleta EJ, Arora A, Wolk DM. Matrix-assisted laser desorption ionization-time of flight mass spectrometry: a fundamental shift in the routine practice of clinical microbiology. Clinical microbiology reviews. 2013 Jul:26(3):547-603. doi: 10.1128/CMR.00072-12. Epub [PubMed PMID: 23824373]
Vartivarian SE, Anaissie EJ, Kiwan EN, Papadakis KA. The clinical spectrum of stenotrophomonas (xanthomonas) maltophilia respiratory infection. Seminars in respiratory and critical care medicine. 2000:21(4):349-55 [PubMed PMID: 16088746]
Matson HH, Jones BM, Wagner JL, Motes MA, Bland CM. Growing resistance in Stenotrophomonas maltophilia? American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2019 Dec 2:76(24):2004-2005. doi: 10.1093/ajhp/zxz247. Epub [PubMed PMID: 31789358]
Vartivarian S, Anaissie E, Bodey G, Sprigg H, Rolston K. A changing pattern of susceptibility of Xanthomonas maltophilia to antimicrobial agents: implications for therapy. Antimicrobial agents and chemotherapy. 1994 Mar:38(3):624-7 [PubMed PMID: 8203865]
Mendes ET, Paez JIG, Ferraz JR, Marchi AP, Silva ILAFE, Batista MV, Lima ALM, Rossi F, Levin AS, Costa SF. Clinical and microbiological characteristics of patients colonized or infected by Stenotrophomonas maltophilia : is resistance to sulfamethoxazole/trimethoprim a problem? Revista do Instituto de Medicina Tropical de Sao Paulo. 2020:62():e96. doi: 10.1590/S1678-9946202062096. Epub 2020 Dec 7 [PubMed PMID: 33295480]
Hu LF, Chen GS, Kong QX, Gao LP, Chen X, Ye Y, Li JB. Increase in the Prevalence of Resistance Determinants to Trimethoprim/Sulfamethoxazole in Clinical Stenotrophomonas maltophilia Isolates in China. PloS one. 2016:11(6):e0157693. doi: 10.1371/journal.pone.0157693. Epub 2016 Jun 16 [PubMed PMID: 27310255]
Milne KE, Gould IM. Combination antimicrobial susceptibility testing of multidrug-resistant Stenotrophomonas maltophilia from cystic fibrosis patients. Antimicrobial agents and chemotherapy. 2012 Aug:56(8):4071-7. doi: 10.1128/AAC.00072-12. Epub 2012 May 14 [PubMed PMID: 22585220]
Church D, Lloyd T, Peirano G, Pitout J. Antimicrobial susceptibility and combination testing of invasive Stenotrophomonas maltophilia isolates. Scandinavian journal of infectious diseases. 2013 Apr:45(4):265-70. doi: 10.3109/00365548.2012.732240. Epub 2012 Oct 31 [PubMed PMID: 23113657]
Level 2 (mid-level) evidenceElufisan TO, Luna ICR, Oyedara OO, Varela AS, García VB, Oluyide BO, Treviño SF, López MAV, Guo X. Antimicrobial susceptibility pattern of Stenotrophomonas species isolated from Mexico. African health sciences. 2020 Mar:20(1):168-181. doi: 10.4314/ahs.v20i1.22. Epub [PubMed PMID: 33402905]
Yilmaz M, Celik AF, Mert A. Successfully treated nosocomial Stenotrophomonas maltophilia bacteremia following desensitization to trimethoprim-sulfamethoxazole. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy. 2007 Apr:13(2):122-3 [PubMed PMID: 17458682]
Level 3 (low-level) evidenceDi Bonaventura G, Spedicato I, D'Antonio D, Robuffo I, Piccolomini R. Biofilm formation by Stenotrophomonas maltophilia: modulation by quinolones, trimethoprim-sulfamethoxazole, and ceftazidime. Antimicrobial agents and chemotherapy. 2004 Jan:48(1):151-60 [PubMed PMID: 14693533]
Adegoke AA, Stenström TA, Okoh AI. Stenotrophomonas maltophilia as an Emerging Ubiquitous Pathogen: Looking Beyond Contemporary Antibiotic Therapy. Frontiers in microbiology. 2017:8():2276. doi: 10.3389/fmicb.2017.02276. Epub 2017 Nov 30 [PubMed PMID: 29250041]
Weiss K, Restieri C, De Carolis E, Laverdière M, Guay H. Comparative activity of new quinolones against 326 clinical isolates of Stenotrophomonas maltophilia. The Journal of antimicrobial chemotherapy. 2000 Mar:45(3):363-5 [PubMed PMID: 10702558]
Level 2 (mid-level) evidencePankuch GA, Jacobs MR, Appelbaum PC. Susceptibilities of 123 Xanthomonas maltophilia strains to clinafloxacin, PD 131628, PD 138312, PD 140248, ciprofloxacin, and ofloxacin. Antimicrobial agents and chemotherapy. 1994 Feb:38(2):369-70 [PubMed PMID: 8192468]
Liu YM, Chen YS, Toh HS, Huang CC, Lee YL, Ho CM, Lu PL, Ko WC, Chen YH, Wang JH, Tang HJ, Yu KW, Liu YC, Chuang YC, Xu Y, Ni Y, Liu CE, Hsueh PR. In vitro susceptibilities of non-Enterobacteriaceae isolates from patients with intra-abdominal infections in the Asia-Pacific region from 2003 to 2010: results from the Study for Monitoring Antimicrobial Resistance Trends (SMART). International journal of antimicrobial agents. 2012 Jun:40 Suppl():S11-7. doi: 10.1016/S0924-8579(12)70004-3. Epub [PubMed PMID: 22749053]
Sader HS, Flamm RK, Jones RN. Tigecycline activity tested against antimicrobial resistant surveillance subsets of clinical bacteria collected worldwide (2011). Diagnostic microbiology and infectious disease. 2013 Jun:76(2):217-21. doi: 10.1016/j.diagmicrobio.2013.02.009. Epub 2013 Mar 19 [PubMed PMID: 23522845]
Wang YL, Scipione MR, Dubrovskaya Y, Papadopoulos J. Monotherapy with fluoroquinolone or trimethoprim-sulfamethoxazole for treatment of Stenotrophomonas maltophilia infections. Antimicrobial agents and chemotherapy. 2014:58(1):176-82. doi: 10.1128/AAC.01324-13. Epub 2013 Oct 21 [PubMed PMID: 24145530]
Level 2 (mid-level) evidenceWatson L, Esterly J, Jensen AO, Postelnick M, Aguirre A, McLaughlin M. Sulfamethoxazole/trimethoprim versus fluoroquinolones for the treatment of Stenotrophomonas maltophilia bloodstream infections. Journal of global antimicrobial resistance. 2018 Mar:12():104-106. doi: 10.1016/j.jgar.2017.09.015. Epub 2017 Sep 28 [PubMed PMID: 28964955]
Flamm RK, Shortridge D, Castanheira M, Sader HS, Pfaller MA. In Vitro Activity of Minocycline against U.S. Isolates of Acinetobacter baumannii-Acinetobacter calcoaceticus Species Complex, Stenotrophomonas maltophilia, and Burkholderia cepacia Complex: Results from the SENTRY Antimicrobial Surveillance Program, 2014 to 2018. Antimicrobial agents and chemotherapy. 2019 Nov:63(11):. doi: 10.1128/AAC.01154-19. Epub 2019 Oct 22 [PubMed PMID: 31427295]
Jacobson S, Junco Noa L, Wallace MR, Bowman MC. Clinical outcomes using minocycline for Stenotrophomonas maltophilia infections. The Journal of antimicrobial chemotherapy. 2016 Dec:71(12):3620 [PubMed PMID: 27516472]
Level 2 (mid-level) evidenceCastanheira M, Mendes RE, Jones RN. Update on Acinetobacter species: mechanisms of antimicrobial resistance and contemporary in vitro activity of minocycline and other treatment options. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2014 Dec 1:59 Suppl 6():S367-73. doi: 10.1093/cid/ciu706. Epub [PubMed PMID: 25371512]
Sader HS, Farrell DJ, Flamm RK, Jones RN. Antimicrobial susceptibility of Gram-negative organisms isolated from patients hospitalised with pneumonia in US and European hospitals: results from the SENTRY Antimicrobial Surveillance Program, 2009-2012. International journal of antimicrobial agents. 2014 Apr:43(4):328-34. doi: 10.1016/j.ijantimicag.2014.01.007. Epub 2014 Feb 7 [PubMed PMID: 24630306]
Nicodemo AC, Araujo MR, Ruiz AS, Gales AC. In vitro susceptibility of Stenotrophomonas maltophilia isolates: comparison of disc diffusion, Etest and agar dilution methods. The Journal of antimicrobial chemotherapy. 2004 Apr:53(4):604-8 [PubMed PMID: 14973153]
Gales AC, Reis AO, Jones RN. Contemporary assessment of antimicrobial susceptibility testing methods for polymyxin B and colistin: review of available interpretative criteria and quality control guidelines. Journal of clinical microbiology. 2001 Jan:39(1):183-90 [PubMed PMID: 11136768]
Level 2 (mid-level) evidenceTsiodras S,Pittet D,Carmeli Y,Eliopoulos G,Boucher H,Harbarth S, Clinical implications of stenotrophomonas maltophilia resistant to trimethoprim-sulfamethoxazole: a study of 69 patients at 2 university hospitals. Scandinavian journal of infectious diseases. 2000; [PubMed PMID: 11200376]
Level 2 (mid-level) evidenceLivermore DM, Mushtaq S, Warner M, Woodford N. Comparative in vitro activity of sulfametrole/trimethoprim and sulfamethoxazole/trimethoprim and other agents against multiresistant Gram-negative bacteria. The Journal of antimicrobial chemotherapy. 2014 Apr:69(4):1050-6. doi: 10.1093/jac/dkt455. Epub 2013 Nov 19 [PubMed PMID: 24257317]
Level 2 (mid-level) evidenceZhanel GG, Golden AR, Zelenitsky S, Wiebe K, Lawrence CK, Adam HJ, Idowu T, Domalaon R, Schweizer F, Zhanel MA, Lagacé-Wiens PRS, Walkty AJ, Noreddin A, Lynch Iii JP, Karlowsky JA. Cefiderocol: A Siderophore Cephalosporin with Activity Against Carbapenem-Resistant and Multidrug-Resistant Gram-Negative Bacilli. Drugs. 2019 Feb:79(3):271-289. doi: 10.1007/s40265-019-1055-2. Epub [PubMed PMID: 30712199]
Kish T. New Antibiotics in Development Target Highly Resistant Gram-Negative Organisms. P & T : a peer-reviewed journal for formulary management. 2018 Feb:43(2):116-120 [PubMed PMID: 29386869]
Hackel MA, Tsuji M, Yamano Y, Echols R, Karlowsky JA, Sahm DF. In Vitro Activity of the Siderophore Cephalosporin, Cefiderocol, against Carbapenem-Nonsusceptible and Multidrug-Resistant Isolates of Gram-Negative Bacilli Collected Worldwide in 2014 to 2016. Antimicrobial agents and chemotherapy. 2018 Feb:62(2):. doi: 10.1128/AAC.01968-17. Epub 2018 Jan 25 [PubMed PMID: 29158270]
Pfaller MA, Huband MD, Rhomberg PR, Flamm RK. Surveillance of Omadacycline Activity against Clinical Isolates from a Global Collection (North America, Europe, Latin America, Asia-Western Pacific), 2010-2011. Antimicrobial agents and chemotherapy. 2017 May:61(5):. doi: 10.1128/AAC.00018-17. Epub 2017 Apr 24 [PubMed PMID: 28223386]
Almer LS, Hoffrage JB, Keller EL, Flamm RK, Shortridge VD. In vitro and bactericidal activities of ABT-492, a novel fluoroquinolone, against Gram-positive and Gram-negative organisms. Antimicrobial agents and chemotherapy. 2004 Jul:48(7):2771-7 [PubMed PMID: 15215148]
Doi Y. Treatment Options for Carbapenem-resistant Gram-negative Bacterial Infections. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2019 Nov 13:69(Suppl 7):S565-S575. doi: 10.1093/cid/ciz830. Epub [PubMed PMID: 31724043]
Gibson RL, Burns JL, Ramsey BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. American journal of respiratory and critical care medicine. 2003 Oct 15:168(8):918-51 [PubMed PMID: 14555458]
Hu LF, Gao LP, Ye Y, Chen X, Zhou XT, Yang HF, Liiu YY, Mei Q, Li JB. Susceptibility of Stenotrophomonas maltophilia clinical strains in China to antimicrobial combinations. Journal of chemotherapy (Florence, Italy). 2014 Oct:26(5):282-6. doi: 10.1179/1973947814Y.0000000168. Epub 2014 Mar 4 [PubMed PMID: 24588423]
Betts JW, Phee LM, Woodford N, Wareham DW. Activity of colistin in combination with tigecycline or rifampicin against multidrug-resistant Stenotrophomonas maltophilia. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2014 Sep:33(9):1565-72. doi: 10.1007/s10096-014-2101-3. Epub 2014 Apr 30 [PubMed PMID: 24781003]
Level 3 (low-level) evidenceRojas P, Garcia E, Calderón GM, Ferreira F, Rosso M. Successful treatment of Stenotrophomonas maltophilia meningitis in a preterm baby boy: a case report. Journal of medical case reports. 2009 Jul 17:3():7389. doi: 10.4076/1752-1947-3-7389. Epub 2009 Jul 17 [PubMed PMID: 19830198]
Level 3 (low-level) evidenceGeller DE, Flume PA, Griffith DC, Morgan E, White D, Loutit JS, Dudley MN. Pharmacokinetics and safety of MP-376 (levofloxacin inhalation solution) in cystic fibrosis subjects. Antimicrobial agents and chemotherapy. 2011 Jun:55(6):2636-40. doi: 10.1128/AAC.01744-10. Epub 2011 Mar 28 [PubMed PMID: 21444699]
Level 1 (high-level) evidenceGil-Gil T, Martínez JL, Blanco P. Mechanisms of antimicrobial resistance in Stenotrophomonas maltophilia: a review of current knowledge. Expert review of anti-infective therapy. 2020 Apr:18(4):335-347. doi: 10.1080/14787210.2020.1730178. Epub 2020 Feb 21 [PubMed PMID: 32052662]
Defoirdt T. Quorum-Sensing Systems as Targets for Antivirulence Therapy. Trends in microbiology. 2018 Apr:26(4):313-328. doi: 10.1016/j.tim.2017.10.005. Epub 2017 Nov 10 [PubMed PMID: 29132819]
Senol E, DesJardin J, Stark PC, Barefoot L, Snydman DR. Attributable mortality of Stenotrophomonas maltophilia bacteremia. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2002 Jun 15:34(12):1653-6 [PubMed PMID: 12032905]
Level 2 (mid-level) evidenceMuder RR, Harris AP, Muller S, Edmond M, Chow JW, Papadakis K, Wagener MW, Bodey GP, Steckelberg JM. Bacteremia due to Stenotrophomonas (Xanthomonas) maltophilia: a prospective, multicenter study of 91 episodes. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 1996 Mar:22(3):508-12 [PubMed PMID: 8852971]
Level 2 (mid-level) evidenceFalagas ME, Kastoris AC, Vouloumanou EK, Rafailidis PI, Kapaskelis AM, Dimopoulos G. Attributable mortality of Stenotrophomonas maltophilia infections: a systematic review of the literature. Future microbiology. 2009 Nov:4(9):1103-9. doi: 10.2217/fmb.09.84. Epub [PubMed PMID: 19895214]
Level 2 (mid-level) evidenceAisenberg G, Rolston KV, Dickey BF, Kontoyiannis DP, Raad II, Safdar A. Stenotrophomonas maltophilia pneumonia in cancer patients without traditional risk factors for infection, 1997-2004. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 2007 Jan:26(1):13-20 [PubMed PMID: 17200840]
Level 2 (mid-level) evidenceHanes SD, Demirkan K, Tolley E, Boucher BA, Croce MA, Wood GC, Fabian TC. Risk factors for late-onset nosocomial pneumonia caused by Stenotrophomonas maltophilia in critically ill trauma patients. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2002 Aug 1:35(3):228-35 [PubMed PMID: 12115086]
Level 2 (mid-level) evidenceWaters V, Yau Y, Prasad S, Lu A, Atenafu E, Crandall I, Tom S, Tullis E, Ratjen F. Stenotrophomonas maltophilia in cystic fibrosis: serologic response and effect on lung disease. American journal of respiratory and critical care medicine. 2011 Mar 1:183(5):635-40. doi: 10.1164/rccm.201009-1392OC. Epub 2010 Oct 1 [PubMed PMID: 20889901]
Level 2 (mid-level) evidenceSacchetti R, De Luca G, Zanetti F. Control of Pseudomonas aeruginosa and Stenotrophomonas maltophilia contamination of microfiltered water dispensers with peracetic acid and hydrogen peroxide. International journal of food microbiology. 2009 Jun 30:132(2-3):162-6. doi: 10.1016/j.ijfoodmicro.2009.04.017. Epub 2009 Apr 24 [PubMed PMID: 19439386]