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. 1996 Dec;40(12):2859–2864. doi: 10.1128/aac.40.12.2859

Stenotrophomonas maltophilia: emergence of multidrug-resistant strains during therapy and in an in vitro pharmacodynamic chamber model.

M W Garrison 1, D E Anderson 1, D M Campbell 1, K C Carroll 1, C L Malone 1, J D Anderson 1, R J Hollis 1, M A Pfaller 1
PMCID: PMC163636  PMID: 9124855

Abstract

Emergence of Stenotrophomonas maltophilia as a nosocomial pathogen is becoming increasingly apparent. Pleiotropic resistance characterizes S. maltophilia. Furthermore, a slow growth rate and an increased mutation rate generate discordance between in vitro susceptibility testing and clinical outcome. Despite original susceptibility, drug-resistant strains of S. maltophilia are often recovered from patients receiving beta-lactams, quinolones, or aminoglycosides. Given the disparity among various in vitro susceptibility methods, this study incorporated a unique pharmacodynamic model to more accurately characterize the bacterial time-kill curves and mutation rates of four clinical isolates of S. maltophilia following exposure to simulated multidose regimens of ceftazidime, ciprofloxacin, gentamicin, and ticarcillin-clavulanate. Time-kill data demonstrated regrowth of S. maltophilia with all four agents. With the exception of ticarcillin-clavulanate, viable bacterial counts at the end of 24 h exceeded the starting inoculum. Ciprofloxacin only reduced bacterial counts by less than 1.0 log prior to rapid bacterial regrowth. Resistant mutant strains, identical to their parent strain by pulsed-field gel electrophoresis, were observed following exposure to each class of antibiotic. Mutant strains also had distinct susceptibility patterns. These data are consistent with previous reports which suggest that S. maltophilia, despite susceptibility data that imply that the organism is sensitive, develops multiple forms of resistance quickly and against several classes of antimicrobial agents. Standard in vitro susceptibility methods are not completely reliable for detecting resistant S. maltophilia strains; and therefore, interpretation of these results should be done with caution. In vivo studies are needed to determine optimal therapy against S. maltophilia infections.

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Selected References

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  1. Cullmann W. Antibiotic susceptibility and outer membrane proteins of clinical Xanthomonas maltophilia isolates. Chemotherapy. 1991;37(4):246–250. doi: 10.1159/000238862. [DOI] [PubMed] [Google Scholar]
  2. Elting L. S., Khardori N., Bodey G. P., Fainstein V. Nosocomial infection caused by Xanthomonas maltophilia: a case-control study of predisposing factors. Infect Control Hosp Epidemiol. 1990 Mar;11(3):134–138. doi: 10.1086/646136. [DOI] [PubMed] [Google Scholar]
  3. Felegie T. P., Yu V. L., Rumans L. W., Yee R. B. Susceptibility of Pseudomonas maltophilia to antimicrobial agents, singly and in combination. Antimicrob Agents Chemother. 1979 Dec;16(6):833–837. doi: 10.1128/aac.16.6.833. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Garrison M. W., Vance-Bryan K., Larson T. A., Toscano J. P., Rotschafer J. C. Assessment of effects of protein binding on daptomycin and vancomycin killing of Staphylococcus aureus by using an in vitro pharmacodynamic model. Antimicrob Agents Chemother. 1990 Oct;34(10):1925–1931. doi: 10.1128/aac.34.10.1925. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hohl P., Frei R., Aubry P. In vitro susceptibility of 33 clinical case isolates of Xanthomonas maltophilia. Inconsistent correlation of agar dilution and of disk diffusion test results. Diagn Microbiol Infect Dis. 1991 Sep-Oct;14(5):447–450. doi: 10.1016/0732-8893(91)90072-n. [DOI] [PubMed] [Google Scholar]
  6. Khardori N., Elting L., Wong E., Schable B., Bodey G. P. Nosocomial infections due to Xanthomonas maltophilia (Pseudomonas maltophilia) in patients with cancer. Rev Infect Dis. 1990 Nov-Dec;12(6):997–1003. doi: 10.1093/clinids/12.6.997. [DOI] [PubMed] [Google Scholar]
  7. Laing F. P., Ramotar K., Read R. R., Alfieri N., Kureishi A., Henderson E. A., Louie T. J. Molecular epidemiology of Xanthomonas maltophilia colonization and infection in the hospital environment. J Clin Microbiol. 1995 Mar;33(3):513–518. doi: 10.1128/jcm.33.3.513-518.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Lecso-Bornet M., Pierre J., Sarkis-Karam D., Lubera S., Bergogne-Berezin E. Susceptibility of Xanthomonas maltophilia to six quinolones and study of outer membrane proteins in resistant mutants selected in vitro. Antimicrob Agents Chemother. 1992 Mar;36(3):669–671. doi: 10.1128/aac.36.3.669. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Manian F. A., Alford R. H. Discrepancies between disk diffusion and broth susceptibility studies of the activity of ticarcillin plus clavulanic acid against ticarcillin-resistant Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1986 Jul;30(1):35–38. doi: 10.1128/aac.30.1.35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Marshall W. F., Keating M. R., Anhalt J. P., Steckelberg J. M. Xanthomonas maltophilia: an emerging nosocomial pathogen. Mayo Clin Proc. 1989 Sep;64(9):1097–1104. doi: 10.1016/s0025-6196(12)64979-9. [DOI] [PubMed] [Google Scholar]
  11. Mett H., Rosta S., Schacher B., Frei R. Outer membrane permeability and beta-lactamase content in Pseudomonas maltophilia clinical isolates and laboratory mutants. Rev Infect Dis. 1988 Jul-Aug;10(4):765–769. doi: 10.1093/clinids/10.4.765. [DOI] [PubMed] [Google Scholar]
  12. Morrison A. J., Jr, Hoffmann K. K., Wenzel R. P. Associated mortality and clinical characteristics of nosocomial Pseudomonas maltophilia in a university hospital. J Clin Microbiol. 1986 Jul;24(1):52–55. doi: 10.1128/jcm.24.1.52-55.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Pankuch G. A., Jacobs M. R., Appelbaum P. C. Susceptibilities of 123 Xanthomonas maltophilia strains to clinafloxacin, PD 131628, PD 138312, PD 140248, ciprofloxacin, and ofloxacin. Antimicrob Agents Chemother. 1994 Feb;38(2):369–370. doi: 10.1128/aac.38.2.369. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Pankuch G. A., Jacobs M. R., Rittenhouse S. F., Appelbaum P. C. Susceptibilities of 123 strains of Xanthomonas maltophilia to eight beta-lactams (including beta-lactam-beta-lactamase inhibitor combinations) and ciprofloxacin tested by five methods. Antimicrob Agents Chemother. 1994 Oct;38(10):2317–2322. doi: 10.1128/aac.38.10.2317. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Poulos C. D., Matsumura S. O., Willey B. M., Low D. E., McGeer A. In vitro activities of antimicrobial combinations against Stenotrophomonas (Xanthomonas) maltophilia. Antimicrob Agents Chemother. 1995 Oct;39(10):2220–2223. doi: 10.1128/aac.39.10.2220. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Rolston K. V., Messer M., Ho D. H. Comparative in vitro activities of newer quinolones against Pseudomonas species and Xanthomonas maltophilia isolated from patients with cancer. Antimicrob Agents Chemother. 1990 Sep;34(9):1812–1813. doi: 10.1128/aac.34.9.1812. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Sanders C. C., Iaconis J. P., Bodey G. P., Samonis G. Resistance to ticarcillin-potassium clavulanate among clinical isolates of the family Enterobacteriaceae: role of PSE-1 beta-lactamase and high levels of TEM-1 and SHV-1 and problems with false susceptibility in disk diffusion tests. Antimicrob Agents Chemother. 1988 Sep;32(9):1365–1369. doi: 10.1128/aac.32.9.1365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Sanders C. C., Sanders W. E., Jr Type I beta-lactamases of gram-negative bacteria: interactions with beta-lactam antibiotics. J Infect Dis. 1986 Nov;154(5):792–800. doi: 10.1093/infdis/154.5.792. [DOI] [PubMed] [Google Scholar]
  19. Vartivarian S. E., Papadakis K. A., Palacios J. A., Manning J. T., Jr, Anaissie E. J. Mucocutaneous and soft tissue infections caused by Xanthomonas maltophilia. A new spectrum. Ann Intern Med. 1994 Dec 15;121(12):969–973. doi: 10.7326/0003-4819-121-12-199412150-00011. [DOI] [PubMed] [Google Scholar]
  20. 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 Mar;38(3):624–627. doi: 10.1128/aac.38.3.624. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Villarino M. E., Stevens L. E., Schable B., Mayers G., Miller J. M., Burke J. P., Jarvis W. R. Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients. Infect Control Hosp Epidemiol. 1992 Apr;13(4):201–206. doi: 10.1086/646510. [DOI] [PubMed] [Google Scholar]

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