感染症学雑誌 第87巻 第 5 号http://journal.kansensho.or.jp/Disp?pdf=0870050596.pdf
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Stenotrophomonas maltophilia is a multi-drug resistant gram-negative bacillus that is emerging as an opportunistic pathogen. It has inherent ability to adhere to foreign materials and form a biofilm, rendering protection from host defenses as well as antimicrobial agents. In addition, Stenotrophomonas has intrinsic or acquired resistance mechanisms to a number of antibiotic classes.
●Stenotrophomonas infections have been associated with high morbidity and mortality (21 to 69 %) in severely immunocompromised and debilitated individuals. Risk factors associated with Stenotrophomonas infection include admission to an intensive care unit, HIV infection, malignancy, cystic fibrosis, neutropenia, mechanical ventilation, central venous catheters, recent surgery, trauma, and previous therapy with broad-spectrum antibiotics.
●Pneumonia and bacteremia are the most common manifestations of Stenotrophomonas infection. Less common manifestations include endocarditis, mastoiditis, peritonitis, meningitis, soft tissue infection, wound infection, urinary tract infection, and ocular infection.
●We suggest trimethoprim-sulfamethoxazole (TMP-SMX) for treatment of infection due to Stenotrophomonas (Grade 2C). The duration of therapy depends on the site of infection; 14 days of therapy is appropriate for bacteremia or hospital-acquired pneumonia, as long as there has been evidence of clinical improvement.
Other agents with in vitro activity against Stenotrophomonas include ceftazidime, ticarcillin-clavulanic acid, levofloxacin, moxifloxacin, minocycline, tigecycline, polymyxins (ie, colistin sulfate), and rifampin.
The role of combination therapy for treatment of serious Stenotrophomonas infections is uncertain. Several groups have reported in vitro synergy for combinations of antibiotics including TMP-SMX plus ceftazidime, TMP-SMX plus ticarcillin-clavulanic acid, and ticarcillin-clavulanic acid plus ciprofloxacin. Thus far, clinical data regarding benefit of combination therapy are lacking. Nonetheless, combination therapy may be appropriate for severely immunocompromised or neutropenic patients prior to the availability of susceptibility testing results or in institutions known to have a high rate of infections with Stenotrophomonas resistant to TMP-SMX . Potential antimicrobial combinations include TMP-SMX plus either ticarcillin-clavulanic acid, a fluoroquinolone, or ceftazidime. Antibiotic therapy can be tailored to susceptibility data and clinical improvement.
●Infection control measures are important to minimize the incidence of Stenotrophomonas infections and for reducing emergence of resistant strains. These measures include appropriate use of antibiotics, avoidance of prolonged or unnecessary use of foreign devices, and adherence to hand hygiene practices．
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