Document Detail


Endocarditis caused by Stenotrophomonas maltophilia: case report and review.
MedLine Citation:
PMID:  8953069     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Stenotrophomonas (Xanthomonas) maltophilia is a rare cause of endocarditis. The extensive resistance of this organism to several antibiotics leaves few options for antimicrobial therapy. In vitro synergism of the combination of trimethoprim-sulfamethoxazole (TMP-SMZ) and ticarcillin/clavulanic acid (TIC/CA) has been demonstrated. To our knowledge, we report the first case of ventriculoatrial cerebrospinal fluid shunt-associated endocarditis due to S. maltophilia. The patient was cured with combination therapy with TMP-SMZ and TIC/CA along with catheter removal. This is also the first report of S. maltophilia endocarditis successfully treated with this antibiotic combination. In a review of the medical literature, only 16 cases of S. maltophilia endocarditis were found. Most patients were intravenous drug users (43.8%) or had either prosthetic heart valves (50%) or an indwelling vascular catheter (18.8%). Although S. maltophilia is usually considered a nosocomial pathogen, about one-half of the cases were community-acquired. Twelve of sixteen patients had left-sided endocarditis. Therapy with a combination of two or more antibiotics was employed in most cases. Seven patients had been given TMP-SMZ therapy, but none had been treated with TIC/CA before. One-half of the patients required cardiac surgery. The overall mortality rate was 33%. Although the optimal antibiotic treatment for S. maltophilia endocarditis remains unknown, the case reported herein reinforces in vitro findings that the combination of TMP-SMZ and TIC/CA may be effective therapy.
Authors:
F Gutiérrez Rodero; M M Masiá; J Cortés; V Ortiz de la Tabla; V Mainar; A Vilar
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  23     ISSN:  1058-4838     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  1996 Dec 
Date Detail:
Created Date:  1997-03-14     Completed Date:  1997-03-14     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1261-5     Citation Subset:  IM    
Affiliation:
Servicio de Medicina Interna, Hospital de la Marina Baixa, Alicante, Spain.
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MeSH Terms
Descriptor/Qualifier:
Clavulanic Acids / therapeutic use
Drug Therapy, Combination / pharmacology*
Endocarditis, Bacterial / blood,  drug therapy*,  microbiology,  physiopathology
Female
Follow-Up Studies
Humans
Microbial Sensitivity Tests
Middle Aged
Ticarcillin / therapeutic use
Trimethoprim-Sulfamethoxazole Combination / therapeutic use*
Ventriculoperitoneal Shunt*
Xanthomonas / drug effects,  isolation & purification*
Chemical
Reg. No./Substance:
0/Clavulanic Acids; 34787-01-4/Ticarcillin; 8064-90-2/Trimethoprim-Sulfamethoxazole Combination; 86482-18-0/ticarcillin-clavulanic acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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