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  • 1 Semmelweis University, Budapest, Hungary
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Sulfamethoxazole-trimethoprim (SXT) is the drug-of-choice in Stenotrophomonas maltophilia caused infections. There has been an increase in resistance to SXT of S. maltophilia over recent years. In this study 30 S. maltophilia clinical isolates resistant to SXT were investigated. Antibiotic susceptibilities for ciprofloxacin, moxifloxacin, levofloxacin, doxycycline, tigecycline, ceftazidime, colistin and chloramphenicol were determined by broth microdilution method. None of the strains were susceptible to ciprofloxacin, tigecycline, ceftazidime or colistin. Only 37% of the isolates were susceptible to levofloxacin or moxifloxacin. Two isolates resistant to all tested antibiotic agents and two others susceptible only to doxycycline were further investigated: susceptibility for combinations of antibiotics was analyzed by checkerboard technique. According to the fractional inhibitory concentration indices calculated, moxifloxacin plus ceftazidime combination was found to be synergistic in each case. Genetic testing revealed the predominance of sul1 gene. Our study concluded that the range of effective antibiotic agents is even more limited in infections caused by SXT-resistant S. maltophilia. In these cases, in vitro synergistic antibiotic combinations could be potential therapeutic options.

  • 1.

    Abbott, I. J., Slavin, M. A., Turnidge, J. D., Thursky, K. A., Worth, L. J.: Stenotrophomonas maltophilia: Emerging disease patterns and challenges for treatment. Expert Rev Anti Infect Ther 9(4), 471488 (2011).

    • Search Google Scholar
    • Export Citation
  • 2.

    Brooke, J. S.: Stenotrophomonas maltophilia: An emerging global opportunistic pathogen. Clin Microbiol Rev 25(1), 241 (2012).

  • 3.

    http://www.eucast.org/clinical_breakpoints/

  • 4.

    Looney, W. J., Narita, M., Mühlemann, K.: Stenotrophomonas maltophilia: An emerging opportunist human pathogen. Lancet Infect Dis 9(5), 312323 (2009).

    • Search Google Scholar
    • Export Citation
  • 5.

    Barbolla, R., Catalano, M., Orman, B. E., Famiglietti, A., Vay, C., Smayevsky, J., Centrón, D., Piñeiro, S. A.: Class 1 integrons increase trimethoprim–sulfamethoxazole MICs against epidemiologically unrelated Stenotrophomonas maltophilia isolates. Antimicrob Agents Chemother 48(2), 666669 (2004).

    • Search Google Scholar
    • Export Citation
  • 6.

    Chang, L. L., Lin, H. H., Chang, C. Y., Lu, P. L.: Increased incidence of class 1 integrons in trimethoprim/sulfamethoxazole–resistant clinical isolates of Stenotrophomonas maltophilia. J Antimicrob Chemother 59(5), 10381039 (2007).

    • Search Google Scholar
    • Export Citation
  • 7.

    Hu, L. F., Chang, X., Ye, Y., Wang, Z. X., Shao, Y. B., Shi, W., Li, X., Li, J. B.: Stenotrophomonas maltophilia resistance to trimethoprim/sulfamethoxazole mediated by acquisition of sul and dfrA genes in a plasmid-mediated class 1 integron. Int J Antimicrob Agents 37(3), 230234 (2011).

    • Search Google Scholar
    • Export Citation
  • 8.

    Hu, L. F., Gao, L. P., Ye, Y., Chen, X., Zhou, X. T., Yang, H. F., Liiu, Y. Y., Mei, Q., Li, J. B.: Susceptibility of Stenotrophomonas maltophilia clinical strains in China to antimicrobial combinations. J Chemother 26(5), 282286 (2014).

    • Search Google Scholar
    • Export Citation
  • 9.

    Brooke, J. S.: New strategies against Stenotrophomonas maltophilia: A serious worldwide intrinsically drug-resistant opportunistic pathogen. Expert Rev Anti Infect Ther 12(1), 14 (2014).

    • Search Google Scholar
    • Export Citation
  • 10.

    San Gabriel, P., Zhou, J., Tabibi, S., Chen, Y., Trauzzi, M., Saiman, L.: Antimicrobial susceptibility and synergy studies of Stenotrophomonas maltophilia isolates from patients with cystic fibrosis. Antimicrob Agents Chemother 48(1), 168171 (2004).

    • Search Google Scholar
    • Export Citation
  • 11.

    Milne, K. E., Gould, I. M.: Combination antimicrobial susceptibility testing of multidrug- resistant Stenotrophomonas maltophilia from cystic fibrosis patients. Antimicrob Agents Chemother 56(8), 40714077 (2012).

    • Search Google Scholar
    • Export Citation
  • 12.

    Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility testing. CLSI approved Standard. M100 S16. CLSI, Wayne, PA, USA, 2012.

    • Export Citation
  • 13.

    Balke, B., Hogardt, M., Schmoldt, S., Hoy, L., Weissbrodt, H., Häussler, S.: Evaluation of the E test for the assessment of synergy of antibiotic combinations against multiresistant Pseudomonas aeruginosa isolates from cystic fibrosis patients. Eur J Clin Microbiol Infect Dis 25(1), 2530 (2006).

    • Search Google Scholar
    • Export Citation
  • 14.

    Betts, J. W., Phee, L. M., Woodford, N., Wareham, D. W.: Activity of colistin in combination with tigecycline or rifampicin against multidrug-resistant Stenotrophomonas maltophilia. Eur J Clin Microbiol Infect Dis 33(9), 15651572 (2014).

    • Search Google Scholar
    • Export Citation
  • 15.

    Garcia, L. S.: Clinical Microbiology Procedures Handbook. 3rd Edition, ASM Press, Washington DC, 2010, Chapter 5.12.

  • 16.

    Silbert, S., Pfaller, M. A., Hollis, R. J., Barth, A. L., Sader, H. S.: Evaluation of three molecular typing techniques for nonfermentative Gram-negative bacilli. Infect Control Hosp Epidemiol 25(10), 847851 (2004).

    • Search Google Scholar
    • Export Citation
  • 17.

    Grape, M., Farra, A., Kronvall, G., Sundström, L.: Integrons and gene cassettes in clinical isolates of co-trimoxazole-resistant Gram-negative bacteria. Clin Microbiol Infect 11(3), 185192 (2005).

    • Search Google Scholar
    • Export Citation
  • 18.

    Juhász, E., Krizsán, G., Lengyel, G., Grósz, G., Pongrácz, J., Kristóf, K.: Infection and colonization by Stenotrophomonas maltophilia: Antimicrobial susceptibility and clinical background of strains isolated at a tertiary care centre in Hungary. Ann Clin Microbiol Antimicrob 13(1), 333 (2014).

    • Search Google Scholar
    • Export Citation
  • 19.

    Giamarellos-Bourboulis, E. J., Karnesis, L., Galani, I., Giamarellou, H.: In vitro killing effect of moxifloxacin on clinical isolates of Stenotrophomonas maltophilia resistant to trimethoprim-sulfamethoxazole. Antimicrob Agents Chemother 46(12), 39973999 (2002).

    • Search Google Scholar
    • Export Citation
  • 20.

    Wu, K., Yau, Y. C., Matukas, L., Waters, V.: Biofilm compared to conventional antimicrobial susceptibility of Stenotrophomonas maltophilia isolates from cystic fibrosis patients. Antimicrob Agents Chemother 57(3), 15461548 (2013).

    • Search Google Scholar
    • Export Citation
  • 21.

    Giamarellos-Bourboulis, E. J., Karnesis, L., Giamarellou, H.: Synergy of colistin with rifampin and trimethoprim/sulfamethoxazole on multidrug-resistant Stenotrophomonas maltophilia. Diagn Microbiol Infect Dis 44(3), 259263 (2002).

    • Search Google Scholar
    • Export Citation
  • 22.

    Church, D., Lloyd, T., Peirano, G., Pitout, J.: Antimicrobial susceptibility and combination testing of invasive Stenotrophomonas maltophilia isolates. Scand J Infect Dis 45(4), 265270 (2013).

    • Search Google Scholar
    • Export Citation
  • 23.

    Visalli, M. A., Jacobs, M. R., Appelbaum, P. C.: Activities of three quinolones, alone and in combination with extended-spectrum cephalosporins or gentamicin, against Stenotrophomonas maltophilia. Antimicrob Agents Chemother 42(8), 20022005 (1998).

    • Search Google Scholar
    • Export Citation
  • 24.

    Entenza, J. M., Moreillon, P.: Tigecycline in combination with other antimicrobials: A review of in vitro, animal and case report studies. Int J Antimicrob Agents 34(1), 8.e19 (2009).

    • Search Google Scholar
    • Export Citation
  • 25.

    Gülmez, D., Cakar, A., Sener, B., Karakaya, J., Hasçelik, G.: Comparison of different antimicrobial susceptibility testing methods for Stenotrophomonas maltophilia and results of synergy testing. J Infect Chemother 16(5), 322328 (2010).

    • Search Google Scholar
    • Export Citation
  • 26.

    Wood, G. C., Underwood, E. L., Croce, M. A., Swanson, J. M., Fabian, T. C.: Treatment of recurrent Stenotrophomonas maltophilia ventilator-associated pneumonia with doxycycline and aerosolized colistin. Ann Pharmacother 44(10), 16651668 (2010).

    • Search Google Scholar
    • Export Citation
  • 27.

    Doern, C. D.: When does 2 plus 2 equal 5? A review of antimicrobial synergy testing. J Clin Microbiol 52(12), 41244128 (2014).

  • 28.

    Toleman, M. A., Bennett, P. M., Bennett, D. M., Jones, R. N., Walsh, T. R.: Global emergence of trimethoprim/sulfamethoxazole resistance in Stenotrophomonas maltophilia mediated by acquisition of sul genes. Emerg Infect Dis 13(4), 559565 (2007).

    • Search Google Scholar
    • Export Citation

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