Stenotrophomonas maltophilia
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Stenotrophomonas maltophilia

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STENOTROPHOMONAS MALTOPHILIA

STENOTROPHOMONAS MALTOPHILIA

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Stenotrophomonas maltophilia Stenotrophomonas maltophilia Presentation Transcript

  • STENOTROPHOMONAS MALTOPHILIA AN EMERGING PATHOGEN Dr.T.V.Rao MDDR.T.V.RAO MD 1
  • STENOTROPHOMONAS MALTOPHILIA• Stenotrophomonas maltophilia is an aerobic, nonfermentative, Gram-negative bacterium. It is an uncommon bacterium and human infection is difficult to treat. Initially classified as Pseudomonas maltophilia, S. maltophilia was also grouped in the genus Xanthomonas before eventually becoming the type species of the genus Stenotrophomonas in 1993DR.T.V.RAO MD 2
  • STENOTROPHOMONAS MALTOPHILIA• Stenotrophomonas maltophilia bacteria, Coloured transmission electron micrograph (TEM). This aerobic Gram-negative bacterium, previously known as Pseudomonas maltophilia, can cause infections in humans and is resistant to many antibiotics. It thrives in wet and moist conditions, and mainly affects patients whose immune systems have been compromised by infection or weakness. A study published in 2008 identified this bacteria as having the capacity to rapidly develop into strains with increased drug resistance..DR.T.V.RAO MD 3
  • ANTIBIOTIC USE PRODUCES NEWER MICROBIAL INFECTIONS• With the widespread use of antibiotics and dramatic improvement in patients survival, newer organisms, such as Stenotrophomonas maltophilia , Achromobacter xylosoxidans and nontuberculous mycobacteria are becoming more widespread. The reasons for their emergence are complex but may relate to the selective pressure exerted by repeated exposure to antibiotic therapy, improved laboratory isolation techniques and enhanced reporting. All may be associated with either simple colonisation or respiratory exacerbations in those persistently colonised with large numbers of these organismDR.T.V.RAO MD 4
  • CHARACTERISTICS OF MALTOPHILIA• S. maltophilia are slightly smaller (0.7–1.8 × 0.4– 0.7 micrometers) than other members of the genus. They are motile due to polar flagella and grow well on MacConkey agar producing pigmented colonies. S. maltophilia are catalase-positive, oxidase-negative (which distinguishes them from most other members of the genus) and have a positive reaction for extracellular DNaseDR.T.V.RAO MD 5
  • COLONIES OF STENOTROPHOMONAS MALTOPHILIA ON MACCONKEY AGAR, INCUBATION PERIOD 3 DAYS AT 30°-35°C DR.T.V.RAO MD 6
  • COLONIES OF STENOTROPHOMONAS MALTOPHILIA ON MUELLER-HINTON AGAR. CULTIVATION 72 HOURS, AEROBIC ATMOSPHERE, 28°C.DR.T.V.RAO MD 7
  • BIOCHEMICAL REACTIONS• BIOCHEMICAL REACTIONS Oxidase negative Acidifies maltose in addition to glucose, lactose ,sucroseDR.T.V.RAO MD 8
  • S. MALTOPHILIA CAN LEAD TO NOSOCOMIAL INFECTIONS• S. maltophilia is ubiquitous in aqueous environments, soil and plants, including water, urine, or respiratory secretions; it has also been used in biotechnology applications. In immunocompromised patients, S. maltophilia can lead to nosocomial infections.DR.T.V.RAO MD 9
  • CATHETERS AND I V LINES A SOURCE OF INFECTION• Most cases of infection tends to occur through use of hospital appliances such as catheters, I.V lines and breathing tubes in immunocompromised people.DR.T.V.RAO MD 10
  • EMERGING IMPORTANCE OF MALTOPHILIA Reports from several centres . This pathogen primarily affects patients with co-morbid illness such as cystic fibrosis, immunosuppression, organ transplantation and malignancies. Infections related to S. maltophilia are associated with high morbidity and mortalityDR.T.V.RAO MD rates 11
  • EMERGING CONCERNS WITH STENOTROPHOMONAS MALTOPHILIA• Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen in the debilitated host. S maltophilia is not an inherently virulent pathogen, but its ability to colonise respiratory-tract epithelial cells and surfaces of medical devices makes it a ready coloniser of hospitalised patients. S maltophilia can cause blood-stream infections and pneumonia with considerable morbidity in immunosuppressed patients. Management of infection is hampered by high-level intrinsic resistance to many antibiotic classes and the increasing occurrence of acquired resistance to the first-line drug co- trimoxazole. Prevention of acquisition and infection depends upon the application of modern infection-control practices, with emphasis on the control of antibiotic use and environmental reservoirs.DR.T.V.RAO MD 12
  • PATHOPHYSIOLOGY • S maltophilia has few pathogenic mechanisms and, for this reason, predominantly results in colonization rather than infection. If infection does occur, invasive medical devices are usually the vehicles through which the organism bypasses normal host defenses. Otherwise, the pathophysiology of this nonfermentative aerobic gram- negative bacillus does not differ from other nonfermentative aerobic organisms.DR.T.V.RAO MD 13
  • S.MALTOPHILIA PRODUCE SEVERAL LIFE THREATING INFECTIONS• In severely ill patients, S. maltophilia causes a wide range of infections such as bacteremia, pulmonary infections, urinary tract infections, wound infections, meningitis and endocarditisDR.T.V.RAO MD 14
  • S.MALTOPHILIA AND CYSTIC FIBROSIS • S.maltophilia is a growing source of latent pulmonary infections. S. maltophilia colonization rates in individuals with cystic fibrosis have been increasing.DR.T.V.RAO MD 15
  • MORTALITY/MORBIDITY• Mortality and morbidity relate to the inoculum of S maltophilia that is able to bypass normal host defense mechanisms.• If an intravenous infusion contains large numbers of S maltophilia, then direct injection into the bloodstream may result in the signs and symptoms associated with gram-negative bacteremia.• Similarly, in the urinary tract, if urological irrigation fluids that contain large numbers of S maltophilia are used during an invasive urological procedure, eg, cystoscopy, then gram- negative bacteremia may occur with its attendant mortality and morbidity, which depend on host factors.DR.T.V.RAO MD 16
  • TMP-SXT IS DRUG OF CHOICE ?• TMP – SXT has been recommended for use in the treatment of S. maltophilia infections based on the in vitro susceptibility data which confirm its high activity and the favorable outcomes observed in patients treated with this agent [ . Although the role of the combination antimicrobial therapy in treating infections due to strains that are susceptible to TMP – SXT is uncertain but the addition of one or more agents to which the isolate is susceptible in vitro is a reasonable consideration if the patient is critically ill or has an underlying hematological malignancyDR.T.V.RAO MD 17
  • RESISTANCE TO TMP-SXT • Several reports have shown that the prevalence of strains that are resistant to TMP – SXT is increasing . The rate of resistance to TMP – SXT ranges from 2% in Canada and Latin America to 10% in Europe • Stenotrophomonas maltophilia resistant to trimethoprim – sulphamethoxazole: an increasing problem • Asma M Al-JasserDR.T.V.RAO MD 18
  • MOLECULAR MECHANISMS OF RESISTANCE IN S.MALTOPHILIA• S. maltophilia exhibits an array of mechanisms that singularly or collectively contribute to its multidrug resistance status. Intrinsic resistance includes inducible efflux pumps and multiple β-lactamase expression but not mutations in the quinolone resistance–determining region . In addition, S. maltophilia can acquire resistance through integrons, transposons, and plasmids . Recently, class 1 integrons have been characterized from S. maltophilia strains isolated in Argentina and Taiwan, which indicates that they contribute to TMP/SMX resistance through the sul1 gene carried as part of the 3´ end of the class 1 integronDR.T.V.RAO MD 19
  • THERAPEUTIC FAILURES A GREAT CONCERN• Therapy for these infections represents a significant challenge both for the clinician and the microbiologist because of this organisms high level of antibiotic resistance to most of the currently used agents and methodological difficulties in susceptibility testing with this organismDR.T.V.RAO MD 20
  • ROLE OF MICROBIOLOGY DEPARTMENTS• The microbiology laboratory also plays a vital role in controlling S. maltophilia infections by continuous monitoring of the prevalence, the provision of local Antibiogram data and the performance of synergistic studies which may help to guide therapy selection.DR.T.V.RAO MD 21
  • CONTROLLING MALTOPHILIA INFECTIONS • The proposed strategies to prevent S. maltophilia infection should be encouraged and they include: the avoidance of inappropriate use of antibiotics, the avoidance of prolonged implementation of foreign devices, the reinforcement of hand hygiene practices and the application of appropriate infection controlDR.T.V.RAO MD practices. 22
  • EFFECTIVE HAND WASHING WILL REDUCE SEVERAL CASES OF NOSOCOMIAL INFECTIONSDR.T.V.RAO MD 23
  • FOR ARTICLES OF INTEREST ONINFECTIOUS DISEASES FOLLOW ME ONDR.T.V.RAO MD 24
  • REFERENCES• 1.Emerging Infectious diseases Volume 13, Number 4–April 2007• 2 American society of Microbiology• 3 science photo libraryDR.T.V.RAO MD 25
  • • Created by Dr.T.V.Rao MD for ‘e’ learning resources for Microbiologists and Health care Workers in Developing World • Email • doctortvrao@gmail.comDR.T.V.RAO MD 26