Clinical and microbiological characteristics of patients colonized or infected by Stenotrophomonas maltophilia : is resistance to sulfamethoxazole/trimethoprim a problem?

Rev Inst Med Trop Sao Paulo. 2020 Dec 7:62:e96. doi: 10.1590/S1678-9946202062096. eCollection 2020.

Abstract

Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen in the last decade. Increased resistance to sulfamethoxazole/trimethoprim (SMX/TMP) has been reported in S. maltophilia strains in the past few years, leading to few therapeutic options. We conducted a prospective multicenter study at two Brazilian teaching hospitals that identified S. maltophilia isolates and evaluated their antimicrobial susceptibility profile, SMX/TMP resistance genes and their clonality profile. A total of 106 non-repeated clinical samples of S. maltophilia were evaluated. Resistance to SMX/TMP was identified in 21.6% of the samples, and previous use of SMX/TMP occurred in 19 (82.6%). PCR detected the sul1 gene in 14 of 106 strains (13.2%). Of these isolates, nine displayed resistance to SMX/TMP. The resistant strains presented a polyclonal profile. This opportunistic pathogen has emerged in immunocompromised hosts, with few therapeutic options, which is aggravated by the description of emerging resistance mechanisms, although with a polyclonal distribution profile.

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Proteins / genetics
  • Brazil
  • DNA, Bacterial / genetics
  • Drug Resistance, Bacterial / drug effects
  • Drug Resistance, Bacterial / genetics*
  • Gram-Negative Bacterial Infections / drug therapy*
  • Gram-Negative Bacterial Infections / epidemiology
  • Gram-Negative Bacterial Infections / microbiology
  • Humans
  • Immunocompromised Host
  • Microbial Sensitivity Tests
  • Polymerase Chain Reaction
  • Prospective Studies
  • Stenotrophomonas maltophilia / drug effects*
  • Stenotrophomonas maltophilia / genetics*
  • Stenotrophomonas maltophilia / isolation & purification
  • Trimethoprim Resistance / genetics
  • Trimethoprim, Sulfamethoxazole Drug Combination / pharmacology*
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • DNA, Bacterial
  • Trimethoprim, Sulfamethoxazole Drug Combination