How do I manage a patient with Stenotrophomonas maltophilia infection?

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection Pub Date : 2025-05-06 DOI:10.1016/j.cmi.2025.04.031

Roberta Monardo, Maria F Mojica, Marco Ripa, Samuel L Aitken, Robert A Bonomo, David van Duin

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Abstract

Background: Stenotrophomonas maltophilia is a Gram-negative bacillus that may cause a range of infections, most frequently bloodstream and respiratory infections. S. maltophilia exhibits intrinsic resistance to several antibiotics including carbapenems. Clinical assessment and treatment of a patient with positive S. maltophilia cultures are challenging.

Objectives: We aimed to provide a resource for clinicians to help diagnose and treat S. maltophilia infections.

Sources: A comprehensive literature search on S. maltophilia infections was conducted using PubMed, with no restrictions on publication date.

Content: The review uses a hypothetical clinical vignette as a context to explore the epidemiology, risk factors, clinical presentation, mortality, diagnostic management, antibiotic resistance mechanisms, and antibiotic management of S. maltophilia infections.

Implications: The assessment and treatment of S. maltophilia infections remain challenging. Standardized indications to distinguish colonization from infection and to guide the start of targeted therapy are lacking. The optimal treatment approach has similarly not been established in randomized controlled trials.

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如何处理嗜麦芽窄养单胞菌感染患者？

背景：嗜麦芽窄养单胞菌是一种革兰氏阴性杆菌，可引起一系列感染，最常见的是血液和呼吸道感染。嗜麦芽葡萄球菌对包括碳青霉烯类在内的几种抗生素表现出内在耐药性。临床评估和治疗患者阳性的嗜麦芽链球菌培养是具有挑战性的。目的：我们旨在为临床医生提供帮助诊断和治疗嗜麦芽链球菌感染的资源。资料来源：在Pubmed上对嗜麦芽链球菌感染进行了全面的文献检索，对发表日期没有限制。内容：本综述以一个假想的临床小故事为背景，探讨嗜麦芽葡萄球菌感染的流行病学、危险因素、临床表现、死亡率、诊断管理、抗生素耐药机制和抗生素管理。意义：嗜麦芽葡萄球菌感染的评估和治疗仍然具有挑战性。目前还缺乏区分定植和感染的标准化指征，以及指导靶向治疗的开始。同样，在随机对照试验中也没有确定最佳治疗方法。临床简介：一名77岁男性，有慢性阻塞性肺疾病和糖尿病病史，因车祸被送入重症监护病房（ICU）。他需要有创机械通气。7天后患者出现发热，c反应蛋白升高(CRP 9.88 mg/dL；正常：≤0.04 mg/dL)，白细胞增多(WBC 17800个细胞/μL；正常范围：3300 ~ 8600 cells/μL)。胸部x线片示右肺浸润。支气管肺泡灌洗培养铜绿假单胞菌和嗜麦芽窄养单胞菌阳性。嗜麦芽链球菌被认为是一种潜在的定植菌，对铜绿假单胞菌开始使用哌哌西林-他唑巴坦进行抗生素治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Microbiology and Infection 医学-传染病学

CiteScore

25.30

自引率

2.10%

发文量

441

审稿时长

2-4 weeks

期刊介绍： Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.