Mortalidad en niños con bacteriemia por Stenotrophomonas maltophilia: revisión sistemática / Mortality in children with Stenotrophomonas maltophilia-related bacteremia: A systematic review

Introducción: En los niños, la bacteriemia por Stenotrophomonas maltophilia es considerada una complicación severa y asociada a una elevada mortalidad. Con el objetivo de conocer la mortalidad asociada a esa condición, se realizó una revisión sistemática de la literatura. Material y métodos: Se aplicó una estrategia de búsqueda bibliográfica con las palabras clave: bacteriemia por Stenotrophomonas maltophilia, niños y adolescentes como únicos filtros. Se informan la mediana y los valores intercuartílicos de la frecuencia de la mortalidad reportada por los estudios incluidos. Resultados: Se identificaron 165 estudios potencialmente útiles. De ellos, se seleccionaron finalmente, 9 estudios para ser incluidos. La incidencia de mortalidad a consecuencia de una bacteriemia por S.maltophilia fue del 25%; Q25: 11­Q75: 36; rango: 6,06 a 40,6. Consideraciones finales: La bacteriemia por Sm tuvo un alto porcentaje de mortalidad en especial en pacientes con patología subyacente y uso de procedimientos invasivos y el uso inadecuado de antibióticos empíricos (AU)

Introduction: In children, Stenotrophomonas maltophilia-related bacteremia is considered a severe complication associated with high mortality. With the aim to determine the mortality associated with this condition, a systematic review of the literature was conducted. Material and methods: A literature search strategy was applied using the keywords: bacteremia due to Stenotrophomonas maltophilia, children, and adolescents as the only filters. The median and interquartile ranges of the mortality rates described in the studies included are reported. Results: A total of 165 potentially useful studies were identified, of which nine were finally selected to be included in the analysis. The incidence of S.maltophilia bacteremia-related mortality was 25%; Q25: 11­Q75: 36; range: 6.06 to 40.6. Final considerations: S.maltophilia-related bacteremia was associated with a high mortality rate especially in patients with an underlying disease, when invasive procedures were performed, and when emperical antibiotics were inadequately used (AU)

Research progress on drug resistance mechanism and treatment of Stenotrophomonas maltophilia / 中华临床感染病杂志

Stenotrophomonas maltophilia is a gram-negative bacillus which widely exists in natural and hospital environment, and it is also one of the common opportunistic pathogens in clinical settings. The virulence and pathogenicity of Stenotrophomonas maltophilia are weak, however, due to resistance to a variety of antibacterial drugs, it can cause bloodstream infections or pneumonia in immunocompromised or critically ill patients, leading to poor prognosis. Moreover, the inherent drug resistance and increasing acquired drug resistance may make the treatment of the first line antibiotics, like trimethoprim-sulfamethoxazole or quinolone ineffective. Therefore, it is important to understand the drug resistance mechanism and the main countermeasures for it. In this article, the research progress on drug resistance mechanism and treatment for Stenotrophomonas maltophilia are reviewed.

Selection of microorganisms and preparation of inoculants with potential applications in the remediation of soil contaminated with hexazinone / Seleção de microrganismos e preparo de inoculantes com potencial de aplicação na remediação de solo contaminado com hexazinona

ABSTRACT: The excessive use of agrochemicals negatively impacts the environment, making the development of sustainable technologies for the reduction of contaminants in soil necessary. Hexazinone is the herbicide most used for sugarcane crops and persists in the environment. Moreover, its main route of degradation in the soil is through microorganisms. Therefore, six microorganisms were selected that presented growth in the presence of the herbicide; SCR1 - Microbacterium arborescens; SCR2 - Bacillus pumilus; SCM3 - Stenotrophomonas maltophilia; SCM4 - Bacillus cereus; SCM5A - M. arborescens; and SCM5B - B. safensis. A test was performed to evaluate the ability of each lineage in phosphate solubilization. For the Ca3(PO4)2 solubilization test, the strains that showed the best results were B. pumilus and S. maltophilia. Subsequently, the inoculants were prepared and the concentrations after plating were 2.71 × 109 CFU mL-1 for B. pumilus, 1.02 × 109 CFU mL-1 for S. maltophilia, and 1.14 × 1010 CFU mL-1 for a combination of the two strains. These were satisfactory values for use as inoculants.

RESUMO: O uso de agroquímicos resulta em impactos ambientais e torna-se necessário o emprego de tecnologias sustentáveis para diminuição de contaminantes no solo. O hexazinona é o herbicida mais utilizado para a cultura da cana-de-açúcar, e apresenta persistência no ambiente. A principal via de degradação no solo é por meio de microrganismos. Com isso, selecionou-se seis microrganismos que apresentaram crescimento na presença do herbicida: SCR1 - Microbacterium arborescens; SCR2 - Bacillus pumilus; SCM3 - Stenotrophomonas maltophilia; SCM4 - Bacillus cereus; SCM5A - M. arborescens; SCM5B - Bacillus safensis. Foi realizado um teste para avaliar a habilidade de cada linhagem na solubilização de fosfatos, e no caso da solubilização de Ca3(PO4)2, as linhagens que apresentaram melhores resultados foram B. pumilus e S. maltophilia. Posteriormente, os inoculantes foram preparados e a concentração após plaqueamento de 2,71x109 UFC mL-1 para B. pumilus, 1,02x109 UFC mL-1 para S. maltophilia e consórcio com as duas linhagens 1,14x1010 UFC mL-1 apresentaram valores satisfatórios para utilização como inoculantes.

A multidrug-resistant Stenotrophomonas maltophilia clinical isolate from Kamuzu Central Hospital, Malawi

Background Stenotrophomonas maltophilia is a significant opportunistic pathogen that is associated with high mortality in immunocompromised individuals. In this study, we describe a multidrug-resistant (MDR) S. maltophilia clinical isolate from Kamuzu Central Hospital (KCH), Lilongwe, Malawi. Methods: A ceftriaxone and meropenem nonsusceptible isolate (Sm-MW08), recovered in December 2017 at KCH, was referred to theNational Microbiology Reference Laboratory for identification. In April 2018, we identified the isolate using MALDI Biotyper mass spectrometry and determined its antimicrobial susceptibility profile using microdilution methods. Sm-MW08 was analysed by S1-PFGE, PCR, and Sanger sequencing, in order to ascertain the genotypes that were responsible for the isolate`s multidrug-resistance (MDR) phenotype. Results Sm-MW08 was identified as S. maltophilia and exhibited resistance to a range of antibiotics, including all ß-lactams, aminoglycosides (except arbekacin), chloramphenicol, minocycline, fosfomycin and fluoroquinolones, but remained susceptible to colistin and trimethoprim-sulfamethoxazole. The isolate did not harbour any plasmid but did carry chromosomally-encoded blaL1 metallo-ßlactamase and blaL2 ß-lactamase genes; this was consistent with the isolate's resistance profile. No other resistance determinants were detected, suggesting that the MDR phenotype exhibited by Sm-MW08 was innate. Conclusion : Herein, we have described an MDR S. maltophilia from KCH in Malawi, that was resistant to almost all locally available antibiotics. We therefore recommend the practice of effective infection prevention measures to curtail spread of this organism

Pharmaceutical Care for a Child with Refractory Stenotrophomonas maltophilia Sepsis by Clinical Pharmacist / 中国药房

OBJECTIVE：To investigate the pharmaceutical ca re for a child with refractory Stenotrophomonas maltophilia sepsis by clinical pharmacists ，and to provide reference for the treatment of children with this disease. METHODS ：Clinical pharmacist participated in drug therapy for a child with refractory S. maltophilia sepsis. Based on the pathophysiological characteristics of the child and the PK/PD characteristics of the antimicrobials ，clinical pharmacists suggested that the anti-infection regimen should be adjusted as cefoperazone sodium and sulbactam sodium 160 mg/（kg·d），every 8 hours combined with levofloxacin 10 mg/kg， every 12 hours. For clinical manifestations of severe inflammatory reaction ， the clinical pharmacist suggested receiving methylprednisolone sodium succinate 1 mg/kg additionally ，every 12 hours，for anti-inflammatory adjuvant therapy. At the same time， clinical pharmacist provided individualized pharmaceutical care （including the detection of blood concentration of cefoperazone sodium and sulbactam sodium ，the detection of ADR and medication education of oxygen atomization ）during the treatment，and followed up the child for one year. RESULTS ：The doctors adopted the suggestions of clinical pharmacists. The sepsis was controlled ，the child ’s condition were improved and then discharged. During the follow-up ，the child did not suffered from ADR ，such as cartilage and joint injury. CONCLUSIONS ：Hypoimmunity，long stay in intensive care unit ，endotracheal intubation and malignant tumor are the high risk factors of S. maltophilia infection. The monitoring of therapeutic drugs of cefoperazone sodium and sulbactam sodium is very necessary in the treatment of severe infection in children. After weighing the advantages and disadvantages and meeting certain conditions ，children can use quinolones for anti-infection ；based on the effective anti-infection treatment ，low-dose glucocorticoid can reduce the systemic inflammatory respense in patients with sepsis.

Bacteriemia por Stenotrophomonas maltophilia en niños: análisis de 10 años / Stenotrophomonas maltophilia bacteremia in children - A 10-year analysis

Stenotrophomonas maltophilia es un microorganismo gramnegativo, multirresistente. La información sobre la bacteriemia por S. maltophilia en niños es limitada. Se revisaron los datos de 10 años de un hospital de niños de alta complejidad. Se incluyó a niños de 0 a 18 años con hemocultivos o cultivos del catéter positivos. Se identificaron 20 cepas de S. maltophilia en 12 niños con infección confirmada, cuya mediana de edad fue 28 meses (intervalo: 3,1-187,3). El índice de antibioticoterapia previa fue 83 %, con una mediana de tres antibióticos (intervalo: 0­7) en los 30 días previos a la bacteriemia por S. maltophilia. La infección relacionada con el catéter fue la principal fuente de infección (8/12). La mortalidad fue de 4/12; y en dos casos, estuvo asociada con neumonía. S. maltophilia puede considerarse un agente muy invasivo productor de bacteriemia en niños con enfermedad preexistente expuestos a antibióticos durante una hospitalización prolongada.

Stenotrophomonas maltophilia is a multidrug-resistant, Gram-negative, and biofilm-forming pathogen. Information is limited concerning S. maltophilia bacteremia in children. Clinical data and microbiological test results collected in a tertiary children's hospital over a ten-year period were reviewed. Children 0­18 years old who had positive clinical specimen, blood and/or catheter cultures were included. We identified 20 S. maltophiliaisolates from 12 pediatric patients with confirmed infections. The median age was 28 months (range: 3.1-187.3). The rate of previous use of antimicrobial therapy was 83 %. The median antibiotic number was 3 (range: 0­7) within 30 days prior to onset of S. maltophilia bacteremia. Catheter related infection was the main infectious source (66.6 %). The mortality rate was 33.3 %. The death of two non-survivors was associated with pneumonia. S. maltophilia should be considered a breakthrough agent for bacteremia in children with underlying disease exposed to broad-spectrum antibiotics during long-term hospitalization

In-Vitro Antimicrobial Activity Of Biological Synthesized Silver Nanoparticles Using Stenotrophomonas Maltophilia Strain Ns-24 From Non-Rhizosphere Soil

Objective: The present goals of our study were biological synthesis, characterizations of silver nanoparticles, and evaluation of its antimicrobial activity against microbial pathogens like Escherichia coli, Enterococcus faecalis, Streptococcus pneumoniae and Staphylococcus aureus. Methods: The bacterial Strain NS-24 was isolated on nutrient agar medium and was selected for the synthesis of silver nanoparticles based on its gram-negative characteristics. The characterizations of silver nanoparticles were done by UV-Visible spectroscopy, Atomic Force Microscopy (AFM), High Resolution-Transmission Electron Microscopy (HR-TEM), Scanning Electron Microscopy (SEM) with Energy Dispersive Spectroscopy (EDX), X-ray Diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR). Later, the molecular characterization of the Strain NS-24 was done by DNA extraction and 16S rRNA gene sequencing. Results: The UV-visible spectrophotometric observation of the Strain NS-24 supernatant and AgNO3 solution showed maximum absorbance at 423 nm. The AFM data confirmed that the particles were polydispersed and spherical in shape. Additionally, the FTIR analysis revealed the IR spectral band patterning and TEM analyzes showed the size of biological AgNPs was in the range of 12.56 nm to 27.32 nm, with an average of 18.06 nm in size. Further, the 16S rRNA gene sequencing revealed the identity of Strain NS-24 as Stenotrophomonas maltophilia. The antimicrobial activity of AgNPs was studied on different gram-negative and gram-positive bacterial strains like Escherichia coli (MTCC 40), Enterococcus faecalis (MTCC 6845), Streptococcus pneumoniae (MTCC 8874) and Staphylococcus aureus (MTCC 2825), which showed good inhibition of their growth at varying concentrations of AgNPs against all the pathogens. Conclusion: Our findings showed that the synthesized AgNPs from the isolated bacterium was small in size and had profound antibacterial activity against pathogenic micro-organisms.

Screening and identification of fibrinolytic enzyme-producing microbes in fermentation process of Sojae Semen Praeparatum / 中草药

Objective: To screen and identify the dominant strains which produce fibrinolytic enzyme during the processing of Sojae Semen Praeparatum (SSP, Dandouchi in Chinese). Methods: SSP was prepared according to the Chinese Pharmacopoeia (2020 edition), and samples were taken at different time points during the fermenting process of SSP.The casein plate method and fibrin plate method were used to screen the fibrinolytic enzyme-producing microorganisms in samples at different time points. The fibrinolytic enzyme-producing microorganisms were inoculated in the designated liquid medium to obtain single strain fermentation broth, and fibrin plate method was used to measure the fibrinolytic activity of the fermentation broth. The DNA sequences of fibrinolytic enzyme-producing bacteria and fungi were amplified using 16S rDNA and 18S rDNA universal primer by PCR respectively.The amplified products were sequenced, and the sequencing results were identified through NCBI homology comparison. Molecular biological identification was done by phylogenetic tree constructed by MEGA 4.1 software. Results: Three types of fibrinolytic enzyme-producing bacteria were screened out and identified in this study. They were Bacillus subtilis, Stenotrophomonas maltophilia and Micrococcus, respectively. The result of fibrin plate method showed that the fermentation broth of S. maltophilia had the highest fibrinolytic activity, reaching 527.49 IU/mL. Conclusion: There are fibrinolytic enzyme-producing dominant microorganisms existing in the fermenting process of SSP and the thrombolytic effect of SSP is worthy of further study. This study lays the foundation for revealing the formation mechanism of fibrinolytic enzyme in the fermentation process of SSP.

Replacement of the native mitral valve due to endocarditis caused by stenotrophomonas maltophilia

Abstract We report a case of a 59-year-old female patient with vegetative native mitral valve endocarditis caused by Stenotrophomonas maltophilia (SM). She had hemodialysis-dependent chronic renal failure, but no immunosuppressive disease. Echocardiography showed mobile vegetation on her native mitral valve. Right femoral artery embolectomy and mitral valve replacement were performed simultaneously. She awakened from anesthesia, but she passed away due to septic shock complications. To the best of our knowledge, this was the first case in whom native mitral valve endocarditis caused by SM was observed (despite of absence of any immunosuppressive event) and needed to undergo valve replacement.

Stenotrophomonas maltophilia: descripción de un agente altamente infeccioso / Stenotrophomonas maltophilia: description of a highly infectious agent

La Stenotrophomonas maltophilia es una bacteria oportunista que causa diversos tipos de infecciones asociadas con la atención sanitaria en pacientes debilitados, especialmente en aquellos que han recibido antimicrobianos de amplio espectro. La Stenotrophomonas maltophilia se posiciona hoy en día como un patógeno nosocomial de ámbito general, el cual se añade a otros multirresistentes como Staphylococcus aureus, Acinetobacter spp. y Pseudomonas aeruginosa. Presentamos este caso dado que es el primero que encontramos en nuestro servicio (el cual simula una infección recurrente por micobacterias) y con el objetivo de demostrar el protocolo utilizado para el diagnóstico y tratamiento. Este germen se reporta con poca frecuencia y todos los pacientes son inmunosuprimidos o con tratamiento antibiótico prolongado. Este agente infeccioso se debe considerar e incluir entre los diagnósticos diferenciales de conglomerados ganglionares abscedados. En pacientes con inmunosupresión sospechada o conocida es necesario descartar la presencia de microorganismos oportunistas, para poder proporcionarle un diagnóstico adecuado y un tratamiento específico.

Stenotrophomonas maltophilia is an opportunistic bacterium that can cause various types of infections associated with health care in debilitated patients, especially those who have previously received broad-spectrum antimicrobials. Stenotrophomonas maltophilia is positioned today as a nosocomial pathogen of general scope, such as adding other multiresistant Staphylococcus aureus, Acinetobacter spp. and Pseudomonas aeruginosa.We present this case because it is the first thing we find in our service (wich simulates a recurrent mycobacterial infection) and with the aim of demonstrating the protocol used in diagnosis and treatment. This germ is infrequently reported and all patients are immunosuppressed or with prolonged antibiotic treatment. This infectious agent should be considered and included in the differential diagnosis of lymph node abscessed conglomerates. In patients with suspected or known immunosuppression is necessary to rule out opportunistic organisms, to provide a proper diagnosis and specific treatment.

Prevalência e resistência a antibióticos de Stenotrophomonas maltophilia em amostras clínicas: estudo epidemiológico de 10 anos / Epidemiological and physiological characteristics of clinical isolates of Stenotrophomonas maltophilia: 10 years study

Introdução:Stenotrophomonas maltophilia é um patógeno oportunista emergente, associado, principalmente, a infecções nosocomiais. As opções terapêuticas para o tratamento de infecções por S. maltophilia são limitadas, devido a sua resistência a uma grande variedade de antibióticos. Objetivo: Investigar a prevalência e a resistência aos antibióticos de isolados identificados como S. maltophilia, a partir de pacientes hospitalizados, recuperados em um laboratório clínico, localizado em Juiz de Fora ­ Minas Gerais, bem como analisar dados epidemiológicos destes pacientes. Materiais e Métodos: Isolados consecutivos, não duplicados de S. maltophilia (n=58), referentes ao período de 10 anos foram analisados. Todas as amostras foram identificadas utilizando o sistema automatizado Vitek 2® Compact (BioMérieux/França). Os padrões de resistência aos antibióticos foram realizados utilizando o método de disco difusão. Os prontuários dos pacientes foram avaliados e dados como idade, sexo, espécime clínico, bem como índice de óbito intra-hospitalar atribuído à infecção por S. maltophilia foi igualmente analisado. Resultados: De um total de 39.547 (100%) espécimes clínicos analisados, 58 (0,14%) isolados não replicados foram identificados como S. maltophilia. 70,6% dos isolados de S. maltophilia foram isolados de secreção traqueal e 15,5% de sangue.Todas as amostras foram sensíveis, in vitro, aos antibióticos testados. Frequência de óbito intra-hospitalar associado à infecção por S. maltophilia foi de 44,7%. Indivíduos de ampla faixa etária (0-100 anos) foram acometidos por infecção por S. maltophilia, sendo o sexo feminino o mais prevalente (56,9%). Conclusão: Pneumonia e bacteremia foram as síndromes clínicas mais frequentes causadas por S. maltophila. Constatou-se moderada taxa de mortalidade associada a infecções por S. maltophilia, apesar da alta sensibilidade in vitro aos antibióticos testados. Novos trabalhos se fazem necessários, a fim de gerar dados e informações que possam ser úteis no diagnóstico precoce, manejo e tratamento correto de infecções associadas a S. maltophilia, em especial aquelas com perfil de resistência aos antibóticos.

Introduction:Stenotrophomonas maltophilia is an emerging opportunistic pathogen, mainly associated with nosocomial infections. Therapeutic options for the treatment of S. maltophilia infections are limited because of their resistance to a wide variety of antibiotics. Objective: To investigate the prevalence and antibiotic resistance of isolates identified as S. maltophilia from hospitalized patients recovered from a clinical laboratory located in Juiz de Fora - Minas Gerais, as well as to analyze epidemiological data of these patients. Materials and Methods: Consecutive, non duplicate isolates of S. maltophilia (n=58) for the 10-year period were analyzed. All samples were identified using the automated Vitek 2® Compact system (BioMérieux/France). Antibiotic resistance standards were performed using the disk diffusion method. Patient records were evaluated and data such as age, gender, clinical specimen, and in-hospital death rate attributed to S. maltophilia infection were also analyzed. Results: From a total of 39,547 (100%) clinical specimens analyzed, 58 (0,14%) unreplicated isolates were identified as S. maltophilia. 70,6% of S. maltophilia isolates were isolated from tracheal secretion and 15,5% from blood. All samples were sensitive in vitro to the antibiotics tested. In-hospital death frequency associated with S. maltophilia infection was 44,7%. Individuals from a wide age range (0-100 years) were affected by S. maltophilia infection, with females being the most prevalent (56,9%). Conclusion: Pneumonia and bacteremia were the most frequent clinical syndromes caused by S. maltophila. A moderate mortality rate associated with S. maltophila infections was observed, despite the high sensitivity in vitro to the antibiotics tested. New studies are necessary in order to generate data and information that may be useful in early diagnosis, management and correct treatment of infections associated with S. maltophila, especially those with a profile of antibiotic resistance.

Clinical features and prognosis of children with hematological malignancies after chemotherapy with Stenotrophomonas maltophilia blood stream infection / 白血病·淋巴瘤

Objective To investigate the clinical features and prognosis of children with hematological malignancies after chemotherapy accompanied with Stenotrophomonas maltophilia blood stream infection (BSI). Methods The clinical data and antimicrobial susceptibility test of 25 hospitalized children with hematological malignancies who were diagnosed as Stenotrophomonas maltophilia BSI in the Department Pediatric Hematology of Fujian Medical University Union Hospital from January 2013 to May 2018 were analyzed retrospectively. Results A total of 25 children, including 18 males and 7 females with the median age 4 (1-11) years old were diagnosed as hematological malignancies and all received chemotherapy. The frequent risk factors of Stenotrophomonas maltophilia BSI in children with hematological malignancies included prior carbapenem antibiotic for more than 1 week (80％, 20/25), and neutropenia for more than 1 week (68％,17/25) and indwelling central venous catheter (48％, 12/25). Clinically, the main manifestations included neutropenia with fever after chemotherapy; however, anti-pseudomonas cephalosporin/carbicillin antibiotic combined with vancomycin and anti-fungal therapies were ineffective. Drug susceptibility test showed that all strains were sensitive to compound sulfamethoxazole, levofloxacin and minocycline. Before blood culture report, 3 patients died of septic shock, pulmonary hemorrhage and respiratory failure; after blood culture report, the treatment regimens were adjusted to compound sulfamethoxazole combined with cefoperazone sodium and sulbactam sodium (200-260 mg·kg-1·d-1) or levofloxacin anti-infective. Finally, 18 patient was cured, 2 patients died of the bad efficacy of underlying diseases, and 2 patients died of pulmonary hemorrhage. The overall fatality rate was 28％ (7/25) and the related mortality rate caused by Stenotrophomonas maltophilia BSI was 20％ (5/25). Conclusion Stenotrophomonas maltophilia BSI in children with hematological malignancies after chemotherapy has a high fatality rate, and better basic disease control and appropriate antibacterial therapy are the key to improve the prognosis.

Effect of antimicrobial use density on resistance rate of Stenotrophomonas maltophilia / 中国感染控制杂志

Objective To analyze the correlation between antimicrobial use density (AUD) and change in antimicrobial resistance rate of Stenotrophomonas maltophilia (SM), and explore the influencing factors of antimicrobial resistance of SM. Methods Antimicrobial resistance rate of SM and AUD of commonly used antimicrobial agents in patients in a hospital from 2012 to 2017 were summarized, correlation was analyzed with Pearson correlation method. Results A total of 23 994 strains of gram-negative bacteria were isolated, of which 1 331 strains (5.55％) were SM, mainly from sputum (54.02％) and distributed in intensive care unit (21.49％). Resistance rates of SM to ceftazidime, levofloxacin, and compound sulfamethoxazole were 21.79％, 7.66％, and 13.37％ respectively, resistance rates to levofloxacin showed an increasing trend year by year (P＜0.05). Resistance rate of SM to levofloxacin was positively correlated with the use intensity of β-lactamase inhibitors, carbapenems, fluoroquinolones, and oxazolidinones (all P＜0.05); resistance rate to compound sulfamethoxazole was positively correlated with the use intensity of macrolides (P＜0.05).Conclusion Change in resistance rates of SM to levofloxacin and compound sulfamethoxazole are positively correlated with the use intensity of some commonly used antimicrobial agents, reducing AUD is beneficial to the control and reducing of the resistance of SM.

Detection of blaNDM-1 in Stenotrophomonas maltophilia isolated from Brazilian soil

This study reports the presence of the blaNDM-1 gene in an isolate of Stenotrophomonas maltophilia obtained from a Brazilian soil, inside an IncA/C plasmid with ~ 45 Kb. To the best of our knowledge, this is the second report in the world and the first in Brazil of NDM-producing bacterium isolated from soil.

Clinical characteristics of burn patients infected with Stenotrophomonas maltophilia and antibiotic resistance of the strains / 中华烧伤杂志

Objective@#To investigate the clinical characteristics of burn patients infected with Stenotrophomonas maltophilia (SM) and antibiotic resistance of the strains.@*Methods@#Clinical data of burn patients detected with SM, admitted to our unit from July 2011 to July 2017 were retrospectively analyzed. API 20NE bacteria identification panel or fully automated microbial identification instrument was used to identify pathogen. Minimal inhibitory concentration method was used in drug sensitivity test of levofloxacin, compound sulfamethoxazole, minocycline, and cefoperazone/sulbactam. Annual detection of SM, clinical characteristics and prognosis of patients infected with SM, sample source and detection time of SM, detection of the pathogens and antibiotics application of patients before their detection of SM, and drug resistance of SM to the above four antibiotics were analyzed. The results of drug sensitivity test were analyzed by software WHONET 5.5.@*Results@#(1) There were totally 119 patients detected with SM, with 11, 12, 21, 22, 28, 13, and 12 cases from 2011 to 2017, respectively. (2) Among patients infected with SM, there were 86 (72.3%) males and 33 (27.7%) females. Patients aged more than or equal to 65 years accounted for 11.8% (14/119). Patients aged more than or equal to 18 years and less than 65 years accounted for 76.5% (91/119). Patients aged less than 18 years accounted for 11.8% (14/119). Patients with scald were the most common (totally 72 cases, accounted for 60.5%), and patients with total burn area less than or equal to 10% total body surface area were the most common (totally 35 cases, accounted for 29.4%), too. The proportion of patients with history of basic disease was 16.8% (20/119), with tracheotomy of 46.2% (55/119), with deep vein catheterization of 47.9% (57/119), with history of staying in intensive care unit (ICU) of 61.3% (73/119). Seventy-five (63.0%) patients were cured. Twenty-four (20.2%) patients were improved. Fourteen (11.8%) patients gave up treatment. Six (5.0%) patients died. (3) SM detected from wounds exudate of patients occupied the highest proportion (58.0%, 69/119), which was followed by samples of sputum (17.6%, 21/119), blood (14.3%, 17/119), wound tissue (4.2%, 5/119), catheter (4.2%, 5/119), and urine (1.7%, 2/119). The detection time of SM was 10 hours to 71 days post admission, with the average time of 12.7 days. (4) The proportion of patients detected with pathogens before detection of SM was 66.4% (79/119), and Acinetobacter baumannii and Staphylococcus aureus occupied high proportion among the strains. (5) The proportion of patients using antibiotics before detection of SM was 91.6% (109/119), and 44.0% (48/109) patients used 3 kinds of antibiotics or more. The antibiotics were applied for 271 times. The most frequently used antibiotics were glycopeptides antibiotics (63 times), followed by carbapenems antibiotics (61 times). (6) The total sensitivity rates of SM to levofloxacin and minocycline in 7 years were high (91.6% and 99.4%, respectively). The total sensitivity rate of SM to cefoperazone/sulbactam was low (52.5%). The total sensitivity rate of SM to compound sulfamethoxazole was high (77.6%), and the annual sensitivity rate was higher than 90.0% in recent 3 years.@*Conclusions@#Burn patients infecting SM have high rates of tracheotomy and deep vein catheterization, and most of them stay in ICU and use broad-spectrum antibiotics. SM has high sensitivity to levofloxacin, minocycline, and compound sulfamethoxazole.

Analysis of Drug Resistance of 3 Non-fermentative Gram-negative Bacilli in Our Hospital during 2004-2016 / 中国药房

OBJECTIVE:To provide reference for rational selection of antibiotics against non-fermentative Gram-negative bacilli in clinic. METHODS:Etiological data of clinical isolated Pseudomonas aeruginosa(PA),Acinetobacter baumanii(AB) and Stenotrophomonas maltophilia(SM)were collected from the Affiliated Hospital of Qingdao University(called"our hospital"for short)during Jan. 2004-Dec. 2016. Drug resistance of them to commonly used antibiotics was analyzed retrospectively. RESULTS:Totally 15 587 strains of PA,7 446 strains of AB and 2 950 strains of SM were detected. Resistance rates of PA to commonly used antibiotics fluctuated but were in a decreasing tendency. Except for imipenem,resistance rates of PA to commonly used antibiotics decreased significantly,and resistance rates of PA to amikacin and gentamicin decreased to 4.60% and 7.48%, respectively. Resistance rates of AB to most commonly used antibiotics were more than 40%,but it was sensitive to tigecycline (drug resistance of 0-4.03%). Resistance rates of SM to cefoperazone sodium and sulbactam sodium increased from 3.03% in 2004 to 39.01% in 2016,but it was sensitive to sulfamethoxazole,minocycline and levofloxacin. CONCLUSIONS:Non-fermentative Gram- negative bacilli detected in our hospital are mainly PA. Resistance rate of PA to most of the antibiotics is declining;drug resistance of AB is severe;resistance rates of SM to cefoperazone sodium and sulbactam sodium show increasing tendency.Above 3 non-fermentative Gram-negative bacilli are sensitive to amikacin,tegocycline and minocycline. Clinical selection should be based on the results of drug sensitivity test.

The characteristics and outcome of Stenotrophomonas maltophilia bacteremia in patients with neutropenia / 天津医药

@#Objective To investigate the characteristics and outcome of Stenotrophomonas maltophilia bacteremia in patients with neutropenia. Methods The clinical data of Stenotrophomonas maltophilia bacteremia in patients with neutropenia from January 2006 to December 2016 were respectively analyzed. Results In 32 patients with neutropenia, there were 20 cases with acute leukemia, 7 cases with severe aplastic anemian (SAA), and 5 cases of non-hodgkin lymphoma. All patients had long time to use broad-spectrum antibiotic history. Twenty-one patients had central venous catheters and eleven had peripheral venous catheters in situ. Twenty-five patients were found neutropenia due to chemotherapy, and seven cases with bone failure attributed to SAA. Seventeen patients were dead, and fifteen recovered. Drug susceptibility tests showed multiple drug resistance. Stenotrophomonas maltophilia were partially susceptive to tigercycline, trimethoprim - sulfamethoxazole, levofloxacin, cefoperazone-sulbactam. ceftazidime, minocycline and piperacillin-tazobactam. The severe neutropemia, thrombocytopenia, long duration of granulocyte reduction and polymicrobial infection were the adverse prognostic factors. Conclusion Stenotrophomonas maltophilia bacteremia in patients with neutropenia has a high mortality rate, which needs to timely diagnose and treatment with effective antibiotics.

High Genetic Diversity among Stenotrophomonas maltophilia Isolates from Single Hospital: Nosocomial Outbreaks or Genotypic Profile Changes during Subcultures

Background: Stenotrophomonas maltophilia is a non-fermentative gram-negativebacillus which is widely recognised as an important nosocomial pathogen causing pneumonia,blood-stream, wound and urinary tract infections, particularly in immunosuppressed patients. Theaim of this study was to evaluate a nosocomial outbreak of by S. maltophilia in an intensive careunit of a tertiary hospital and evaluate unexpected multiclonality.Methods: A total of 11 isolates from respiratory cultures in intensive care unit of a 24 bedtertiary hospital obtained over a one months period and one isolate obtained from the nebuliserduring environmental screening were investigated. The bacteria were identified by Phoenix 100system. The clonal relatedness was evaluated by PFGE and semi-automated repetitive sequencebasedPCR. Genotyping tests were repeated for 10 serial subcultures.Results: PFGE and DiversiLab yielded 10 genotypic profiles for 12 isolates. Four to eightdifferent genotypes were observed from 10 subcultures of the same isolate.Conclusion: We conclude that, high genetic diversity and supposed multiclonalappearance of the outbreak isolates may be due to changing profiles during subcultures mostprobably depending on hypermutation.

Isolation of Stenotrophomonas maltophilia from clinical samples: An investigation of patterns motility and production of melanin pigment

Objectives To investigate possible sources of Stenotrophomonas maltophilia (S. maltophilia) in the clinical environment. Methods Different samples were collected from Amol City of Iran. Steps for the identification of S. maltophilia included culturing, biochemical tests, polymerase chain reaction (PCR) of 16S rRNA gene and 23S rRNA gene. In addition, production of melanin pigment and patterns of motility of the bacteria, were also investigated. Results In our study, 20 S. maltophilia strains were isolated from clinical sources, oxygen manometer apparatus of hospitals were 7/110 (6.36%), blood was 1/777 (0.13%), sputum was 4/40 (4%), urine was 1/2 947 (0.03%), tap water was 1/240 (0.42%) and dental suction was 6/120 (5%). The isolated bacteria showed production of melanin pigment with rates of strong, moderate, weak, and lack of pigment. Types of motilities were seen in isolates. Conclusions The highest percentage of bacteria is isolated of oxygen manometer system and dental suction, yet has not been reported from oxygen manometer system. These bacteria have also been associated with patients who have respiratory problems, so it is essential for staffs of hospitals to draw attention to this source of bacteria.

Isolation of Stenotrophomonas maltophilia from clinical samples: An investigation of patterns motility and production of melanin pigment

Objectives:To investigate possible sources of Stenotrophomonas maltophilia (S.maltophilia) in the clinical environment.Methods:Different samples were collected from Amol City of Iran.Steps for the identification of S.maltophilia included culturing,biochemical tests,polymerase chain reaction (PCR) of 16S rRNA gene and 23S rRNA gene.In addition,production of melanin pigment and patterns of motility of the bacteria,were also investigated.Results:In our study,20 S.maltophilia strains were isolated from clinical sources,oxygen manometer apparatus of hospitals were 7/1 10 (6.36％),blood was 1/777 (0.13％),sputum was 4/40 (4％),urine was 1/2947 (0.03％),tap water was 1/240 (0.42％) and dental suction was 6/120 (5％).The isolated bacteria showed production of melanin pigment with rates of strong,moderate,weak,and lack of pigment.Types of motilities were seen in isolates.Conclusions:The highest percentage of bacteria is isolated of oxygen manometer system and dental suction,yet has not been reported from oxygen manometer system.These bacteria have also been associated with patients who have respiratory problems,so it is essential for staffs of hospitals to draw attention to this source of bacteria.