J Korean Med Sci.  2013 Jan;28(1):62-66. 10.3346/jkms.2013.28.1.62.

Antimicrobial Susceptibility of Stenotrophomonas maltophilia Isolates from Korea, and the Activity of Antimicrobial Combinations against the Isolates

• Chung HS
• Hong SG
• Kim YR
• Shin KS
• Whang DH
• Ahn JY
• Park YJ
• Uh Y
• Chang CL
• Shin JH
• Lee HS
• Lee K
• Chong Y

• KMID: 2158002
• DOI: http://doi.org/10.3346/jkms.2013.28.1.62

Abstract

The aim of this study was to determine antimicrobial susceptibility of recent clinical Stenotrophomonas maltophilia isolates from Korea, and to compare the activity levels of several combinations of antimicrobials. A total of 206 non-duplicate clinical isolates of S. maltophilia was collected in 2010 from 11 university hospitals. Antimicrobial susceptibility testing was performed using the Clinical Laboratory Standards Institute agar dilution method. In vitro activity of antimicrobial combinations was tested using the checkerboard method. The susceptibility rates to trimethoprim-sulfamethoxazole and minocycline were 96% and 99%, respectively. The susceptibility rate to levofloxacin was 64%. All of four antimicrobial combinations showed synergy against many S. maltophilia isolates. A combination of trimethoprim-sulfamethoxazole plus ticarcillin-clavulanate was most synergistic among the combinations. None of the combinations showed antagonistic activity. Therefore, some of the combinations may be more useful than individual drugs in the treatment of S. maltophilia infection. Further clinical studies are warranted to validate our in vitro test results.

Keyword

Stenotrophomonas maltophilia; Combination Drug Therapy; Trimethoprim-Sulfamethoxazole; Ticarcillin-Clavulanate

MeSH Terms

Anti-Infective Agents/*pharmacology
Gram-Negative Bacterial Infections/microbiology
Hospitals, University
Humans
Microbial Sensitivity Tests
Minocycline/pharmacology
Ofloxacin/pharmacology
Republic of Korea
Stenotrophomonas maltophilia/*drug effects/isolation & purification
Trimethoprim-Sulfamethoxazole Combination/pharmacology
Anti-Infective Agents
Minocycline
Trimethoprim-Sulfamethoxazole Combination
Ofloxacin

Reference

1. Brooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clin Microbiol Rev. 2012. 25:2–41.

2. Abbott IJ, Slavin MA, Turnidge JD, Thursky KA, Worth LJ. Stenotrophomonas maltophilia: emerging disease patterns and challenges for treatment. Expert Rev Anti Infect Ther. 2011. 9:471–488.

3. Jang TN, Wang FD, Wang LS, Liu CY, Liu IM. Xanthomonas maltophilia bacteremia: an analysis of 32 cases. J Formos Med Assoc. 1992. 91:1170–1176.

4. Victor MA, Arpi M, Bruun B, Jonsson V, Hansen MM. Xanthomonas maltophilia bacteremia in immunocompromised hematological patients. Scand J Infect Dis. 1994. 26:163–170.

5. Zhang L, Li XZ, Poole K. Multiple antibiotic resistance in Stenotrophomonas maltophilia: involvement of a multidrug efflux system. Antimicrob Agents Chemother. 2000. 44:287–293.

6. Alonso A, Martinez JL. Multiple antibiotic resistance in Stenotrophomonas maltophilia. Antimicrob Agents Chemother. 1997. 41:1140–1142.

7. Looney WJ, Narita M, Muhlemann K. Stenotrophomonas maltophilia: an emerging opportunist human pathogen. Lancet Infect Dis. 2009. 9:312–323.

8. Liaw SJ, Teng LJ, Hsueh PR, Ho SW, Luh KT. In vitro activities of antimicrobial combinations against clinical isolates of Stenotrophomonas maltophilia. J Formos Med Assoc. 2002. 101:495–501.

9. Muder RR, Harris AP, Muller S, Edmond M, Chow JW, Papadakis K, Wagener MW, Bodey GP, Steckelberg JM. Bacteremia due to Stenotrophomonas (Xanthomonas) maltophilia: a prospective, multicenter study of 91 episodes. Clin Infect Dis. 1996. 22:508–512.

10. Clinical Laboratory and Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-first Informational Supplement. 2011. Wayne:

11. Odds FC. Synergy, antagonism, and what the chequerboard puts between them. J Antimicrob Chemother. 2003. 52:1.

12. Gales AC, Jones RN, Forward KR, Linares J, Sader HS, Verhoef J. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: geographic patterns, epidemiological features, and trends in the SENTRY Antimicrobial Surveillance Program (1997-1999). Clin Infect Dis. 2001. 32:Suppl 2. S104–S113.

13. Sader HS, Jones RN. Antimicrobial susceptibility of uncommonly isolated non-enteric Gram-negative bacilli. Int J Antimicrob Agents. 2005. 25:95–109.

14. Fedler KA, Biedenbach DJ, Jones RN. Assessment of pathogen frequency and resistance patterns among pediatric patient isolates: report from the 2004 SENTRY Antimicrobial Surveillance Program on 3 continents. Diagn Microbiol Infect Dis. 2006. 56:427–436.

15. Laing FP, Ramotar K, Read RR, Alfieri N, Kureishi A, Henderson EA, Louie TJ. Molecular epidemiology of Xanthomonas maltophilia colonization and infection in the hospital environment. J Clin Microbiol. 1995. 33:513–518.

16. Wang WS, Liu CP, Lee CM, Huang FY. Stenotrophomonas maltophilia bacteremia in adults: four years' experience in a medical center in northern Taiwan. J Microbiol Immunol Infect. 2004. 37:359–365.

17. 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. 2004. 48:168–171.

18. Saiman L, Chen Y, Gabriel PS, Knirsch C. Synergistic activities of macrolide antibiotics against Pseudomonas aeruginosa, Burkholderia cepacia, Stenotrophomonas maltophilia, and Alcaligenes xylosoxidans isolated from patients with cystic fibrosis. Antimicrob Agents Chemother. 2002. 46:1105–1107.

19. Betriu C, Sanchez A, Palau ML, Gomez M, Picazo JJ. Antibiotic resistance surveillance of Stenotrophomonas maltophilia, 1993-1999. J Antimicrob Chemother. 2001. 48:152–154.

20. Zhanel GG, DeCorby M, Nichol KA, Wierzbowski A, Baudry PJ, Karlowsky JA, Lagace-Wiens P, Walkty A, Mulvey MR, Hoban DJ. Antimicrobial susceptibility of 3931 organisms isolated from intensive care units in Canada: Canadian National Intensive Care Unit Study, 2005/2006. Diagn Microbiol Infect Dis. 2008. 62:67–80.

21. Valdezate S, Vindel A, Loza E, Baquero F, Canton R. Antimicrobial susceptibilities of unique Stenotrophomonas maltophilia clinical strains. Antimicrob Agents Chemother. 2001. 45:1581–1584.

22. Vartivarian S, Anaissie E, Bodey G, Sprigg H, Rolston K. A changing pattern of susceptibility of Xanthomonas maltophilia to antimicrobial agents: implications for therapy. Antimicrob Agents Chemother. 1994. 38:624–627.

23. Nicodemo AC, Araujo MR, Ruiz AS, Gales AC. In vitro susceptibility of Stenotrophomonas maltophilia isolates: comparison of disc diffusion, Etest and agar dilution methods. J Antimicrob Chemother. 2004. 53:604–608.

24. Weiss K, Restieri C, De Carolis E, Laverdiere M, Guay H. Comparative activity of new quinolones against 326 clinical isolates of Stenotrophomonas maltophilia. J Antimicrob Chemother. 2000. 45:363–365.

25. Travassos LH, Pinheiro MN, Coelho FS, Sampaio JL, Merquior VL, Marques EA. Phenotypic properties, drug susceptibility and genetic relatedness of Stenotrophomonas maltophilia clinical strains from seven hospitals in Rio de Janeiro, Brazil. J Appl Microbiol. 2004. 96:1143–1150.

26. Wu H, Wang JT, Shiau YR, Wang HY, Yang Lauderdale TL, Chang SC. A multicenter surveillance of antimicrobial resistance on Stenotrophomonas maltophilia in Taiwan. J Microbiol Immunol Infect. 2012. 45:120–126.

27. Chung HS, Hong SG, Lee Y, Kim M, Yong D, Jeong SH, Lee K, Chong Y. Antimicrobial susceptibility of Stenotrophomonas maltophilia isolates from a Korean tertiary care hospital. Yonsei Med J. 2012. 53:439–441.

28. Belvisi V, Fabietti P, Del Borgo C, Marocco R, Di Vincenzo E, Soscia F, Mastroianni CM. Successful treatment of Stenotrophomonas maltophilia soft tissue infection with tigecycline: a case report. J Chemother. 2009. 21:367–368.

29. Blanquer D, De Otero J, Padilla E, Gomez F, Mayol A, Irigaray R, Espejo P, Rada MA, Makrantoni G, Perez AR. Tigecycline for treatment of nosocomial-acquired pneumonia possibly caused by multi-drug resistant strains of Stenotrophomonas maltophilia. J Chemother. 2008. 20:761–763.

30. Galles AC, Jones RN, Sader HS. Antimicrobial susceptibility profile of contemporary clinical strains of Stenotrophomonas maltophilia isolates: can moxifloxacin activity be predicted by levofloxacin MIC results? J Chemother. 2008. 20:38–42.

31. Farrell DJ, Sader HS, Jones RN. Antimicrobial susceptibilities of a worldwide collection of Stenotrophomonas maltophilia isolates tested against tigecycline and agents commonly used for S. maltophilia infections. Antimicrob Agents Chemother. 2010. 54:2735–2737.

32. Chen YH, Lu PL, Huang CH, Liao CH, Lu CT, Chuang YC, Tsao SM, Chen YS, Liu YC, Chen WY. Trends in the susceptibility of clinically important resistant bacteria to tigecycline: results from the Tigecycline In Vitro Surveillance in Taiwan study, 2006 to 2010. Antimicrob Agents Chemother. 2012. 56:1452–1457.

33. Poulos CD, Matsumura SO, Willey BM, Low DE, McGeer A. In vitro activities of antimicrobial combinations against Stenotrophomonas (Xanthomonas) maltophilia. Antimicrob Agents Chemother. 1995. 39:2220–2223.

34. Gulmez D, Cakar A, Sener B, Karakaya J, Hascelik G. Comparison of different antimicrobial susceptibility testing methods for Stenotrophomonas maltophilia and results of synergy testing. J Infect Chemother. 2010. 16:322–328.