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Emerging Global Opportunistic Pathogen. Abstract. Summary: Stenotrophomonas maltophilia is an emerging multidrug- resistant global opportunistic pathogen. The increasing incidence of nosocomial and community- acquired S. S. maltophilia is an environmental bacterium found in aqueous habitats, including plant rhizospheres, animals, foods, and water sources.

Infections of S. maltophilia can occur in a range of organs and tissues; the organism is commonly found in respiratory tract infections. This review summarizes the current literature and presents S. S. maltophilia can be recovered from polymicrobial infections, most notably from the respiratory tract of cystic fibrosis patients, as a cocolonizer with Pseudomonas aeruginosa.

Recent evidence of cell- cell communication between these pathogens has implications for the development of novel pharmacological therapies. Animal models of S. Current and emerging treatments for patients infected with S. INTRODUCTIONClinical microbiologists have long recognized the importance of identifying infectious microbial pathogens as the cause of disease in humans. The emergence of new multiple- drug- resistant (MDR) organisms (MDROs) found in nonclinical environments, the increasing reports of community- acquired infections, and the spread of these pathogens in the clinical setting have all underscored the need to monitor these organisms.

The increase in reported cases of MDRO- associated infections has resulted in efforts to examine possible sources of these pathogens, assess the current antimicrobial strategies used for the treatment of infections, and elucidate the molecular mechanisms used by these pathogens during infection and disease. Gram- negative bacterial pathogens have received much attention, as they are often MDROs due to multidrug resistance pumps, plasmids harboring antibiotic resistance genes, and various gene transfer mechanisms involved in the acquisition of antimicrobial resistance. Pseudomonas aeruginosa is an example of such an MDRO that causes respiratory infections in patients, particularly those with cystic fibrosis (CF) or those with chronic lung diseases. P. aeruginosa has been reported to survive for months on dry surfaces (1.

Stenotrophomonas maltophilia is an environmental global emerging Gram- negative MDRO that is most commonly associated with respiratory infections in humans. It can cause various serious infections in humans. This current review focuses on the strategies used or being developed to treat infections associated with S.

S. maltophilia isolates. HISTORICAL AND CLINICAL SIGNIFICANCE OF S.

MALTOPHILIAS. maltophilia was first isolated in 1. Bacterium bookeri and then named Pseudomonas maltophilia (1. RNA cistron analysis determined that it was more appropriately named Xanthomonas maltophilia (2.

In a large study of Xanthomonas strains, an analysis of 2. X. maltophilia, with 2 of these 7 being type strains of Pseudomonas betle and Pseudomonas hibiscicola (3. There is ongoing debate about nomenclature. DNA- r. RNA hybridization studies and sequencing and mapping of PCR- amplified 1. S r. RNA genes have resulted in the classification and naming of X. S. maltophilia (7.

S. maltophilia is not a highly virulent pathogen, but it has emerged as an important nosocomial pathogen associated with crude mortality rates ranging from 1. For information about the attributable mortality of S. The variety of infections associated with S.

Table 1. Infections associated with S. COPD] [1. 01, 2. 47]); bacteremia (1. S. maltophilia is a significant pathogen in cancer patients, particularly those with obstructive lung cancer. This review will not address in detail infections of S.

S. maltophilia in cancer patients (2. S. maltophilia- associated infections.

S. maltophilia is an environmental MDRO. It has been isolated from aqueous- associated sources both inside and outside the hospital/clinical setting (Table 2). S. maltophilia has been recovered from soils and plant roots, animals (2. A significant feature of S. S. maltophilia has been identified on the surfaces of materials used in intravenous (i. The incidence of S.

S. maltophilia have also been reported. S. maltophilia infections can occur in both children and adults.

The transmission of S. The hands of health care personnel have been reported to transmit nosocomial S. ICU) (3. 07). S. maltophilia has been cocultured with P. CF patients. Cough- generated aerosols from CF patients have the potential to provide airborne transmission of S. Molecular analyses, including ribotyping, pulsed- field gel electrophoresis (PFGE), random amplified polymorphic DNA (RAPD), and enterobacterial repetitive intergenic consensus sequence- PCR (ERIC- PCR), have revealed considerable heterogeneity among S.

S. maltophilia clinical isolates have a higher rate of mutation than environmental isolates, suggesting that clinical isolates adapt to their local environment, e. CF patients (3. 1).

It was proposed that antibiotic resistance gene acquisition by S. These observations emphasize the need to continue the current monitoring of reported cases of S. S. maltophilia isolates from sources within and outside the hospital setting. Hospitals in several different countries perform surveillance on infections due to S.

A U. S. multiple- hospital study of patient infections in the ICU during 1. S. maltophilia as being among the 1.

Gram- negative bacillus isolates) (2. A study of bacteremia in adult patients in a medical center in northern Taiwan during 1. S. maltophilia bacteremia included ICU stay (P = 0. CVC) use (P = 0. 0.

P = 0. 0. 08) (3. During 1. 99. 3 to 2. Taiwan indicated that risk factors associated with mortality in patients with S. P = 0. 0. 49), failure to remove the central venous catheter (P = 0. P = 0. 0. 5) (3. 72).

A study during 1. S. maltophilia bacteremia in two hospitals and a medical center in Taiwan identified thrombocytopenia (P = 0. S. maltophilia shock (P = 0. In a U. S. study of CF sputum microbiology from 1. S. maltophilia increased from 6.

P = 0. 0. 1), and S. FEV1) (P = 0. 0. 7) (9. The data from the CF Foundation Patient Registry from 1. P ≤ 0. 0. 01) in the incidence (range = 3. S. maltophilia across all age groups of patients studied (age, 0 to > 2. Data from the SENTRY Antimicrobial Surveillance Program during 1. S. maltophilia from hospitalized patients with pneumonia from 2.

United States, 3. Europe, and 2. 3% for Latin America (1.

In a British study of adult CF patients during 1. S. maltophilia in their respiratory tract increased (P = 0. P = 0. 0. 29) in patients aged 1. In the 2. 00. 4 SENTRY Antimicrobial Surveillance Program, among pediatric patient isolates, S. North America and Latin America but not from Europe (1. Surveillance of Antimicrobial Use and Antimicrobial Resistance in German Intensive Care Units (SARI) monitored S. P = 0. 0. 1) and being in an ICU with > 1.

P = 0. 0. 37) were risk factors for S. MICROBIOLOGYCharacteristics of S.

S. maltophilia is a Gram- negative obligate aerobe that is rod shaped and motile with a few polar flagella. It is able to persist in nutrient- poor aqueous environments (Table 2).

The growth characteristics of S. Table 3. Standard microbiology reference data currently indicate that S.

Recent data, however, suggest that some S. Growth characteristics of S. Burdge et al. reported the misidentification of S.

Pseudomonas cepacia (4. In that study, 3 (9%) of 3. P. cepacia isolates as a result of a delayed reading (3 min instead of within 1 min) of the oxidase test and not holding the tests for DNase production 7. The misinterpretation of these tests has clinical importance, as P. CF patients. S. maltophilia has been coisolated with other microorganisms (e.

Pseudomonas aeruginosa, Burkholderia species, Staphylococcus aureus, methicillin- resistant S. Acinetobacter baumannii, Escherichia coli, Klebsiella species, Enterobacter species, Enterococcus species, Bacteroides species, Corynebacterium species, and Candida albicans) in samples recovered from patients (1.