akinohanayuki ブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

Stenotrophomonas maltophilia 復習

Stenotrophomonas maltophilia 

菌血症で悩むStenotrophomonas maltophilia 
なお、SM菌血症と略すらしいです。
感染症学雑誌 第87巻 第 5 号http://journal.kansensho.or.jp/Disp?pdf=0870050596.pdf

先日、私も久々にSM菌血症に遭遇し悩みました。幸いにも、重症ではなくST感受性ありでした。

もしも、ST耐性のSM菌血症は、ありったけの併用責め (セフタジジム+キノロン+リファンピシン)でしょうか?

まだまだ不明な点も多いですが

以下、UpToDate より抜粋 引用

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. 

Combination therapy 
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


Stenotrophomonas maltophilia感染症治療に対するRCTは、私のハンドサーチでは見つからなかったです。

Lancet Infect Dis. 2009;9(5):312.
Stenotrophomonas maltophilia: an emerging opportunist human pathogen.

Antimicrob Agents Chemother. 2004;48(1):151.
Biofilm formation by Stenotrophomonas maltophilia: modulation by quinolones, trimethoprim-sulfamethoxazole, and ceftazidime.

J. Antimicrob. Chemother. 2008 Nov; 62(5):889-94.
Therapeutic options for Stenotrophomonas maltophilia infections beyond co-trimoxazole: a systemic review. 

J Hosp Infect. 2008;70(2):101.
Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia: a systematic review.

Clin Infect Dis. 2002;34(12):1653.
Attributable mortality of Stenotrophomonas maltophilia bacteremia.