Role of Stenotrophomonas maltophilia in hospital-acquired infection

ABSTRACT

Stenotrophomonas maltophilia (previously Pseudomonas maltophilia, Xanthomonas maltophilia) is highly resistant to antibiotics. It causes infections that follow in increased morbidity, but not usually mortality, in patients with weakened entertainer defences. The increase in s maltophilia nosocomial infections is to be paid to the changing nature of the hospital patient population and to changes in antibiotic usage. Detection, identification and susceptibility testing rules require improvement, and this complicates the comparison of published data. Susceptibility testing should be reserv for those isolates that are clearly associated with disease. Treatment can be difficult and may be complicated by means of biofilm formation. S. maltophilia can one as well as the other acquire and transfer resistance to antibiotics. subsequent time therapeutic development may be directed against biofilms and flow mechanisms, in order to restore the organism more susceptible to available antimicrobial agents.

KEY WORDS: Bacterial infections.

Drug resistance, bacterial.

Intensive care.

Stenotrophomonas maltophilia.

Introduction

Hospital-acquired infections, otherwise known as nosocomial infections, attitude a threat to patient well-being and to the efficient operation of hospitals. The policies used to limit the spread of similar infections can lead to the temporary closure of certain facilities, the ne to overthrow equipment that cannot be sterilised and to extra duties for personnel This can place significant loads on hospital resources, reducing their capacity to provide care. Hospitals busy a variety of measures to put to proof to prevent nosocomial infections; however, increasing healthcare take away froms mean that preventive strategies must display that they are effective in reducing nosocomial infections and also that they are require to be paid [i]or[/i] undergone effective. Clearly, the key to succes lies in the use of general knowledge of nosocomial pathogens.

Nosocomial infection remains the greatest in quantity common type of complication affecting hospital patients. It is caused by dint of a wide variety of microorganisms and, in greatest in quantity developed countries, 6-10% of patients who move into hospital acquire such an infection.1 Furthermore, more than 20% of patients admitted to European intensive care units (ICUs) evolve an ICU-acquired infection.2 American surveillance data fix that 27% of all nosocomial infections in American medical ICUs were to be paid to pneumonia, with 86% of nosocomial pneumonia associated with mechanical ventilation and primarily to be paid to Gram-negative aerobic organisms.3 Nosocomial pneumonia has been lay the foundation of to increase hospital stay by dint of as much as 14 days.3

A patient who has acquired a nosocomial infection will usually require treatment. The optimal treatment of nosocomial infection requires that antimicrobial therapy be started early in the course of infection, using the correct agent, at the greatest in quantity appropriate dose, and for an adequate duration. like antibiotic prescribing has been shown to significantly restore mortality, length of ICU and hospital stay and overall costs4

Choice of appropriate antimicrobial therapy is complicated by dint of a number of factors, particularly use of antibiotics prior to hospitalisation and to resistant pathogens. Resistance to antimicrobial agents is emerging in a wide variety of pathogens, particularly those that cause nosocomial infection.4 As a event of this, increasing resistance, morbidity and mortality to be paid to nosocomial infection is also increasing.4 single reason for the administration of inappropriate therapy is the nearness of Gram-negative bacteria that are resistant to the newer cephalosporins.

The ubiquitous Gram-negative bacillus Stenotrophomonas maltophilia is intrinsically resistant to many classes of antibiotic and is a significant nosocomial pathogen, particularly in debilitated patients.5,6 In a scan of 20 British medical microbiologists leadershiped in 2000, S. maltophilia was vot the ninth greatest in quantity important multidrug-resistant pathogen.7 Among the Gramnegative bacilli, alone Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp were judg a greater problem7 In the fight against s maltophilia nosocomial infections, the relationship between virulence, transmissibility and antibiotic resistance must first be understood."

Stenotrophomonas maltophilia

Nomenclature

In 1961 s maltophilia was designated P maltophilia upon the basis of its flagellar characteristics.5 In 1983 the fresh name Xanthomonas maltophilia was propos upon the strength of ribosomal RNA (rRNA) homology data,5 on the other hand in 1993 it was mov to the newly formed genus Stenotrophomonas, owed to the inconsistencies it showed with Xanthomonas.5

Occurrence

maltophilia is an environmental organism lay the foundation of in water, soil and upon plants such as fruits, vegetables, flowers and wheat.5,9 Like P aeruginosa, it is ubiquitous in aqueous environments and can be cultur readily from water sources in residences and hospitals.5 It has been isolated from well water, river water, raw milk, frozen fish, raw sewage, human and rabbit faeces,10 and also colonises the gastrointestinal tract.11