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  • Title: Antimicrobial susceptibility and combination testing of invasive Stenotrophomonas maltophilia isolates.
    Author: Church D, Lloyd T, Peirano G, Pitout J.
    Journal: Scand J Infect Dis; 2013 Apr; 45(4):265-70. PubMed ID: 23113657.
    Abstract:
    BACKGROUND: Treatment of invasive Stenotrophomonas maltophilia infections is difficult due to this organism's inherent multidrug resistance and increasing resistance to trimethoprim-sulfamethoxazole via acquisition of the sul genes. METHODS: In vitro antibiotic susceptibility testing was performed using a customized broth microdilution panel. Combination testing for tigecycline with anti-Stenotrophomonas agents (i.e. colistin, ticarcillin-clavulanate, ceftazidime, and levofloxacin) was done using the cross Etest method. Genotyping was done using automated repetitive PCR. RESULTS: A total of 90 patients with invasive S. maltophilia infections included: (79%) adults, and 21% children or infants [6/12 (50%) cases occurred in infants aged ≤ 1 year.]. S. maltophilia isolates were recovered from blood (69%), lower respiratory (21%) or other sites (CSF, peritoneal fluid) (11%). Seventeen percent of the isolates were SXT-R, and also demonstrated multi-drug resistant to two or more antibiotic classes. Minocycline, tigecycline and colistin had the best in vitro activities. The combination testing of tigecycline and colistin gave the best results; 12 isolates were tested and synergy occurred in 3 isolates while an additional 7 isolates showed additive results. CONCLUSIONS: We recommend further evaluation with killing assays and clinical studies to evaluate the effectiveness of tigecycline and colistin combination for invasive S. maltophilia infections.
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