Steno‐sphere: Navigating the enigmatic world of emerging multidrug‐resistant Stenotrophomonas maltophilia
Stenotrophomonas maltophilia is an opportunistic pathogen and frequent cause of serious nosocomial infections. Patient populations at greatest risk for these infections include the immunocompromised and those with chronic respiratory illnesses and prior antibiotic exposure, notably to carbapenems. I...
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| Veröffentlicht in: | Pharmacotherapy 2023-08, Vol.43 (8), p.833-846 |
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| creator | Kunz Coyne, Ashlan J. Herbin, Shelbye Caniff, Kaylee Rybak, Michael J. |
| description | Stenotrophomonas maltophilia is an opportunistic pathogen and frequent cause of serious nosocomial infections. Patient populations at greatest risk for these infections include the immunocompromised and those with chronic respiratory illnesses and prior antibiotic exposure, notably to carbapenems. Its complex virulence and resistance profile drastically limit available antibiotics, and incomplete breakpoint and pharmacokinetic/pharmacodynamic (PK/PD) data to inform dose optimization further complicates therapeutic approaches. Clinical comparison data of first‐line agents, including trimethoprim‐sulfamethoxazole (TMP‐SMX), quinolones, and minocycline, are limited to conflicting observational data with no clear benefit of a single agent or combination therapy. Newer antibiotic approaches, including cefiderocol and aztreonam‐ avibactam, are promising alternatives for extensively drug‐resistant isolates; however, clinical outcomes data are needed. The potential clinical utility of bacteriophage for compassionate use in treating S. maltophilia infections remains to be determined since data is limited to in‐vitro and sparse in‐vivo work. This article provides a review of available literature for S. maltophilia infection management focused on related epidemiology, resistance mechanisms, identification, susceptibility testing, antimicrobial PK/PD, and emerging therapeutic strategies. |
| doi_str_mv | 10.1002/phar.2828 |
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Patient populations at greatest risk for these infections include the immunocompromised and those with chronic respiratory illnesses and prior antibiotic exposure, notably to carbapenems. Its complex virulence and resistance profile drastically limit available antibiotics, and incomplete breakpoint and pharmacokinetic/pharmacodynamic (PK/PD) data to inform dose optimization further complicates therapeutic approaches. Clinical comparison data of first‐line agents, including trimethoprim‐sulfamethoxazole (TMP‐SMX), quinolones, and minocycline, are limited to conflicting observational data with no clear benefit of a single agent or combination therapy. Newer antibiotic approaches, including cefiderocol and aztreonam‐ avibactam, are promising alternatives for extensively drug‐resistant isolates; however, clinical outcomes data are needed. The potential clinical utility of bacteriophage for compassionate use in treating S. maltophilia infections remains to be determined since data is limited to in‐vitro and sparse in‐vivo work. This article provides a review of available literature for S. maltophilia infection management focused on related epidemiology, resistance mechanisms, identification, susceptibility testing, antimicrobial PK/PD, and emerging therapeutic strategies.</description><identifier>ISSN: 0277-0008</identifier><identifier>EISSN: 1875-9114</identifier><identifier>DOI: 10.1002/phar.2828</identifier><identifier>PMID: 37199104</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Antibiotics ; Aztreonam ; aztreonam‐avibactam ; bacteriophage ; Carbapenems ; cefiderocol ; Drug resistance ; Epidemiology ; eravacycline ; Minocycline ; Multidrug resistant organisms ; Nosocomial infection ; Nosocomial infections ; omadacycline ; Opportunist infection ; outcomes ; Phages ; Pharmacodynamics ; pharmacodynamics/pharmacokinetics ; Pharmacokinetics ; quinolone ; Quinolones ; resistance ; Respiratory diseases ; Stenotrophomonas maltophilia ; Sulfamethoxazole ; Trimethoprim ; trimethoprim‐sulfamethoxazole ; Virulence</subject><ispartof>Pharmacotherapy, 2023-08, Vol.43 (8), p.833-846</ispartof><rights>2023 Pharmacotherapy Publications, Inc.</rights><rights>Copyright © 2023 Pharmacotherapy Publications, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-278bb3c3531e19341df9a35d9fca79ae145c164bf217e5c315567870d7df56773</citedby><cites>FETCH-LOGICAL-c3538-278bb3c3531e19341df9a35d9fca79ae145c164bf217e5c315567870d7df56773</cites><orcidid>0000-0002-4891-8625 ; 0000-0002-4480-6159 ; 0000-0003-1468-8267 ; 0000-0003-2220-0081</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fphar.2828$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fphar.2828$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37199104$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kunz Coyne, Ashlan J.</creatorcontrib><creatorcontrib>Herbin, Shelbye</creatorcontrib><creatorcontrib>Caniff, Kaylee</creatorcontrib><creatorcontrib>Rybak, Michael J.</creatorcontrib><title>Steno‐sphere: Navigating the enigmatic world of emerging multidrug‐resistant Stenotrophomonas maltophilia</title><title>Pharmacotherapy</title><addtitle>Pharmacotherapy</addtitle><description>Stenotrophomonas maltophilia is an opportunistic pathogen and frequent cause of serious nosocomial infections. Patient populations at greatest risk for these infections include the immunocompromised and those with chronic respiratory illnesses and prior antibiotic exposure, notably to carbapenems. Its complex virulence and resistance profile drastically limit available antibiotics, and incomplete breakpoint and pharmacokinetic/pharmacodynamic (PK/PD) data to inform dose optimization further complicates therapeutic approaches. Clinical comparison data of first‐line agents, including trimethoprim‐sulfamethoxazole (TMP‐SMX), quinolones, and minocycline, are limited to conflicting observational data with no clear benefit of a single agent or combination therapy. Newer antibiotic approaches, including cefiderocol and aztreonam‐ avibactam, are promising alternatives for extensively drug‐resistant isolates; however, clinical outcomes data are needed. The potential clinical utility of bacteriophage for compassionate use in treating S. maltophilia infections remains to be determined since data is limited to in‐vitro and sparse in‐vivo work. This article provides a review of available literature for S. maltophilia infection management focused on related epidemiology, resistance mechanisms, identification, susceptibility testing, antimicrobial PK/PD, and emerging therapeutic strategies.</description><subject>Antibiotics</subject><subject>Aztreonam</subject><subject>aztreonam‐avibactam</subject><subject>bacteriophage</subject><subject>Carbapenems</subject><subject>cefiderocol</subject><subject>Drug resistance</subject><subject>Epidemiology</subject><subject>eravacycline</subject><subject>Minocycline</subject><subject>Multidrug resistant organisms</subject><subject>Nosocomial infection</subject><subject>Nosocomial infections</subject><subject>omadacycline</subject><subject>Opportunist infection</subject><subject>outcomes</subject><subject>Phages</subject><subject>Pharmacodynamics</subject><subject>pharmacodynamics/pharmacokinetics</subject><subject>Pharmacokinetics</subject><subject>quinolone</subject><subject>Quinolones</subject><subject>resistance</subject><subject>Respiratory diseases</subject><subject>Stenotrophomonas maltophilia</subject><subject>Sulfamethoxazole</subject><subject>Trimethoprim</subject><subject>trimethoprim‐sulfamethoxazole</subject><subject>Virulence</subject><issn>0277-0008</issn><issn>1875-9114</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp1kc9O3DAQh62qqGyXHvoCVaRe2kNY24nXdm8IQRcJAeLPOXKSSdarOE5tp2hvfQSekSfB2aU9VOLkGfnzpxn_EPpM8DHBmC6GtXLHVFDxDs2I4CyVhOTv0QxTzlOMsThEH73fRJQsc_oBHWacSElwPkPmLkBvn_88-WENDn4kV-q3blXQfZuENSTQ69bEtkoerevqxDYJGHDtdG_GLujajW187sBrH1Qfkp0wODusrbG98olRXYid7rQ6QgeN6jx8ej3n6OH87P50lV5e_7w4PblMq4xlIqVclGU21QSIzHJSN1JlrJZNpbhUQHJWxU3KhhIOrMoIY0suOK553cSKZ3P0be8dnP01gg-F0b6CrlM92NEXVBBGcyHkhH79D93Y0fVxukixJWUyThCp73uqctZ7B00xOG2U2xYEF1MGxZRBMWUQ2S-vxrE0UP8j_356BBZ74FF3sH3bVNysTm53yhcrWpQ4</recordid><startdate>202308</startdate><enddate>202308</enddate><creator>Kunz Coyne, Ashlan J.</creator><creator>Herbin, Shelbye</creator><creator>Caniff, Kaylee</creator><creator>Rybak, Michael J.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4891-8625</orcidid><orcidid>https://orcid.org/0000-0002-4480-6159</orcidid><orcidid>https://orcid.org/0000-0003-1468-8267</orcidid><orcidid>https://orcid.org/0000-0003-2220-0081</orcidid></search><sort><creationdate>202308</creationdate><title>Steno‐sphere: Navigating the enigmatic world of emerging multidrug‐resistant Stenotrophomonas maltophilia</title><author>Kunz Coyne, Ashlan J. ; Herbin, Shelbye ; Caniff, Kaylee ; Rybak, Michael J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3538-278bb3c3531e19341df9a35d9fca79ae145c164bf217e5c315567870d7df56773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Antibiotics</topic><topic>Aztreonam</topic><topic>aztreonam‐avibactam</topic><topic>bacteriophage</topic><topic>Carbapenems</topic><topic>cefiderocol</topic><topic>Drug resistance</topic><topic>Epidemiology</topic><topic>eravacycline</topic><topic>Minocycline</topic><topic>Multidrug resistant organisms</topic><topic>Nosocomial infection</topic><topic>Nosocomial infections</topic><topic>omadacycline</topic><topic>Opportunist infection</topic><topic>outcomes</topic><topic>Phages</topic><topic>Pharmacodynamics</topic><topic>pharmacodynamics/pharmacokinetics</topic><topic>Pharmacokinetics</topic><topic>quinolone</topic><topic>Quinolones</topic><topic>resistance</topic><topic>Respiratory diseases</topic><topic>Stenotrophomonas maltophilia</topic><topic>Sulfamethoxazole</topic><topic>Trimethoprim</topic><topic>trimethoprim‐sulfamethoxazole</topic><topic>Virulence</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kunz Coyne, Ashlan J.</creatorcontrib><creatorcontrib>Herbin, Shelbye</creatorcontrib><creatorcontrib>Caniff, Kaylee</creatorcontrib><creatorcontrib>Rybak, Michael J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kunz Coyne, Ashlan J.</au><au>Herbin, Shelbye</au><au>Caniff, Kaylee</au><au>Rybak, Michael J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Steno‐sphere: Navigating the enigmatic world of emerging multidrug‐resistant Stenotrophomonas maltophilia</atitle><jtitle>Pharmacotherapy</jtitle><addtitle>Pharmacotherapy</addtitle><date>2023-08</date><risdate>2023</risdate><volume>43</volume><issue>8</issue><spage>833</spage><epage>846</epage><pages>833-846</pages><issn>0277-0008</issn><eissn>1875-9114</eissn><abstract>Stenotrophomonas maltophilia is an opportunistic pathogen and frequent cause of serious nosocomial infections. 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The potential clinical utility of bacteriophage for compassionate use in treating S. maltophilia infections remains to be determined since data is limited to in‐vitro and sparse in‐vivo work. This article provides a review of available literature for S. maltophilia infection management focused on related epidemiology, resistance mechanisms, identification, susceptibility testing, antimicrobial PK/PD, and emerging therapeutic strategies.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>37199104</pmid><doi>10.1002/phar.2828</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-4891-8625</orcidid><orcidid>https://orcid.org/0000-0002-4480-6159</orcidid><orcidid>https://orcid.org/0000-0003-1468-8267</orcidid><orcidid>https://orcid.org/0000-0003-2220-0081</orcidid></addata></record> |
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| subjects | Antibiotics Aztreonam aztreonam‐avibactam bacteriophage Carbapenems cefiderocol Drug resistance Epidemiology eravacycline Minocycline Multidrug resistant organisms Nosocomial infection Nosocomial infections omadacycline Opportunist infection outcomes Phages Pharmacodynamics pharmacodynamics/pharmacokinetics Pharmacokinetics quinolone Quinolones resistance Respiratory diseases Stenotrophomonas maltophilia Sulfamethoxazole Trimethoprim trimethoprim‐sulfamethoxazole Virulence |
| title | Steno‐sphere: Navigating the enigmatic world of emerging multidrug‐resistant Stenotrophomonas maltophilia |
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