Stenotrophomonas infections
Stenotrophomonas infections are primarily caused by the bacterium Stenotrophomonas maltophilia, which is commonly found in various environmental sources such as water, soil, and plants, as well as in hospital settings where contamination can occur through medical equipment and solutions. Although S. maltophilia is not highly virulent and can colonize human secretions without causing illness, it can lead to serious infections when introduced into the body, particularly in individuals with weakened immune systems or chronic health conditions like diabetes or cystic fibrosis.
Symptoms of Stenotrophomonas infections can vary widely and may include fever, respiratory issues such as cough and shortness of breath, urinary problems, and in severe cases, sepsis or meningitis. Diagnosis typically involves symptom evaluation alongside laboratory cultures from affected tissues or fluids. Treatment options are limited due to antibiotic resistance, but trimethoprim/sulfamethoxazole is often the first-line therapy for these infections.
Preventing Stenotrophomonas infections is challenging due to the bacterium's prevalence. In healthcare settings, strict hygiene and isolation protocols are essential to reduce the risk of transmission and protect vulnerable patients. Overall, understanding the risks and potential symptoms of Stenotrophomonas infections is crucial for timely diagnosis and appropriate treatment.
Stenotrophomonas infections
- ANATOMY OR SYSTEM AFFECTED: All
Definition
Stenotrophomonas infections are caused by the bacterial microorganism Stenotrophomonas maltophilia, which is common in the environment and can be found in bodies of water, soil, and plants. It is also commonly found in hospitals, mainly in contaminated solutions and on medical equipment. S. maltophilia, which can be carried by humans, is not a particularly virulent organism.
Causes
S. maltophilia is an aerobic, gram-negative bacillus. It is able to colonize body secretions without causing an infection. To cause infection, it must be introduced into the body by contaminated medical equipment, devices, or solutions; by eating contaminated food or drinks, including tap water; or by the hands of healthcare workers. Usually, the body’s normal defenses are able to resist S. maltophilia infections.
Risk Factors
Stenotrophomonas infections usually develop in persons who have existing chronic diseases or who are immunosuppressed. Chronic diseases include diabetes, heart disease, chronic obstructive pulmonary disease, and cystic fibrosis. Immunosuppressed persons are those who are on chemotherapy or glucocorticoid drugs or who have acquired immunodeficiency syndrome. Organ transplantation, the prolonged use of certain antibiotics, and hospital-related factors such as mechanical ventilation or the use of medical devices are additional risk factors.
Symptoms
S. maltophilia can cause sepsis, pneumonia, urinary tract infections, soft tissue infections, eye infections, endocarditis, and meningitis. Common symptoms of infection are fever; elevated heart rate; decreased blood pressure; pain, redness, and swelling at the site; and fatigue. Pneumonia causes shortness of breath, a productive cough, and wheezing. Urinary tract infection causes frequency, burning on urination, and cloudy, foul-smelling urine. Endocarditis causes decreased cardiac output, irregular heartbeat, and heart failure. Meningitis causes vomiting, lethargy, a decreased level of consciousness, neck pain, and confusion.
Screening and Diagnosis
There is no routine screening for S. maltophilia infections. Diagnosis depends on the symptoms of infection and a culture of the organism from the affected tissue. Also, cultures can be performed on the blood, urine, spinal fluid, and sputum.
Treatment and Therapy
Stenotrophomonas infections are treated with antibiotics. S. maltophilia is resistant to penicillin, cephalosporin, gentamicin, and tobramycin, so, usually, S. maltophilia infections can be treated with minocycline, cefiderocol, levaquin, ciprofloxacin, and colistin/polymyxin B. However, trimethoprim/sulfamethoxazole has become a first-line choice for use in Stenotrophomonas infections.
Prevention and Outcomes
There is no way to prevent Stenotrophomonas infection in susceptible persons because S. maltophilia is so common. In hospital settings, persons with S. maltophilia infections should be isolated, and medical staff should maintain careful isolation procedures. Medical equipment, linens, furniture, and rooms should be carefully cleaned after patient treatment. Culturing of intravenous solutions, medical devices, and irrigation fluids should be performed periodically to ensure their sterility.
Bibliography
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Brooke, J. S. "Stenotrophomonas maltophilia: An Emerging Global Opportunistic Pathogen." Clinical Microbiology Reviews, vol. 25, no. 1, Jan. 2012, pp. 2-41. PubMed Central, doi:10.1128/CMR.00019-11. Accessed 8 Nov. 2024.
Denton, Miles, and Kevin G. Kerr. "Microbiological and Clinical Aspects of Infection Associated with Stenotrophomonas maltophilia." Clinical Microbiology Reviews, vol. 11, 1998, pp. 57-80.
Kim, Jae-Han, et al. "Two Episodes of Stenotrophomonas maltophilia Endocarditis of Prosthetic Mitral Valve." Journal of the Korean Medical Society, vol. 17, 2002, pp. 263-265.
Said, Mina S., et al. "Stenotrophomonas Maltophilia - StatPearls." NCBI, 12 June 2023, www.ncbi.nlm.nih.gov/books/NBK572123. Accessed 8 Nov. 2024.
Toleman, M. A., et al. "Global Emergence of Trimethoprim/Sulfamethoxazole Resistance in Stenotrophomonas maltophilia Mediated by Acquisition of Sul Genes." Emerging Infectious Diseases, vol. 13, 2007, pp. 559-565.
Wang, Nan, et al. "Risk Factors for Acquired Stenotrophomonas maltophilia Pneumonia in Intensive Care Unit: A Systematic Review and Meta-Analysis." Frontiers in Medicine, vol. 8, Jan. 2022, p. 808391. PubMed Central, doi:10.3389/fmed.2021.808391. Accessed 8 Nov. 2024.