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15 December 2007

Volume 45, Number 12
Clinical Infectious Diseases 2007;45:1602–1609
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4512-0012$15.00
DOI: 10.1086/522998
IMMUNOCOMPROMISED HOSTS INVITED ARTICLE

Stenotrophomonas maltophilia: Changing Spectrum of a Serious Bacterial Pathogen in Patients with Cancer

Amar Safdar and

Kenneth V. Rolston

The M. D. Anderson Cancer Center, University of Texas, Houston

Stenotrophomonas maltophilia colonization/infection in patients with cancer has significantly increased over the past 2 decades. Patients with prolonged neutropenia, exposure to broad‐spectrum antibiotics, and those requiring mechanical ventilation have higher risk of infection. These micro‐organisms are intrinsically resistant to carbapenems, and exposure to these agents has been linked to selection of S. maltophilia. Recently, these infections are being documented in patients without traditional risk factors. The spectrum of infection includes bacteremia, catheter‐related infection, pneumonia, complicated biliary and urinary tract infection, and skin and skin‐structure infection. Trimethoprim‐sulfamethoxazole is the therapeutic agent of choice, but resistance is increasingly being reported. Susceptibility to alternative agents is unpredictable. Combination therapy and alternative routes of drug administration, such as aerosolized aminoglycoside, might be necessary. New insights into the mechanisms of drug resistance might lead to identification of new target sites. Agents that improve outer‐membrane permeability and broad‐spectrum β‐lactamase inhibitors may favorably impact difficult‐to‐treat (i.e., multidrug resistant) S. maltophilia infections.

Received 18 June 2007; accepted 7 August 2007; electronically published 8 November 2007.

Reprints or correspondence: Dr. Amar Safdar, Dept. of Infectious Diseases, Infection Control, and Employee Health, 402, The M. D. Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd., Houston, TX 77030 ().

David R. Snydman, Section Editor

Cited by

Kenneth V. I. Rolston. (2009) New antimicrobial agents for the treatment of bacterial infections in cancer patients. Hematological Oncology n/a-n/a
Online publication date: 1-Feb-2009.
CrossRef
M. E. Falagas, P.-E. Valkimadi, Y.-T. Huang, D. K. Matthaiou, P.-R. Hsueh. (2008) Therapeutic options for Stenotrophomonas maltophilia infections beyond co-trimoxazole: a systematic review. Journal of Antimicrobial Chemotherapy 62:5, 889-894
Online publication date: 18-Aug-2008.
CrossRef
Joseph S. Cervia, Girolamo A. Ortolano, and Francis P. Canonica. (2008) Hospital Tap Water as a Source of Stenotrophomonas maltophilia Infection. Clinical Infectious Diseases 46:9, 1485-1487
Online publication date: 1-May-2008.
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