Document Detail


Severe cellulitis/myositis caused by Stenotrophomonas maltophilia.
MedLine Citation:
PMID:  11816260     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To present a case of cellulitis/myositis due to Stenotrophomonas maltophilia in the absence of trauma and to discuss a potentially novel treatment option. CASE SUMMARY: A 57-year-old white man, having undergone an allogeneic bone marrow transplant, developed myositis with S. maltophilia of the left soleus muscle; there had been no trauma. Risk factors for infection included neutropenia, prolonged hospitalization and intensive care unit stay, and broad-spectrum antibiotic exposure. The affected area of muscle was resected and the patient successfully treated with trimethoprim/sulfamethoxazole (TMP/SMX), ticarcillin/clavulanate, and aztreonam. DISCUSSION: In severe myositis/cellulitis caused by S. maltophilia, TMP/SMX is considered the drug of choice. However, bacteriostatic agents such as TMP/SMX are less than ideal in neutropenic patients. The combination of ticarcillin/clavulanate plus aztreonam has been shown to improve activity in vitro against this organism compared with TMP/SMX. This is likely due to inhibition of the 2 beta-lactamases this organism produces by clavulanate and aztreonam. In our study of clinical isolates of S. maltophilia, this combination reduced the minimum inhibitory concentration at 90% by 128-fold and was synergistic against 10 of 12 isolates tested in time-kill analysis. CONCLUSIONS: S. maltophilia is emerging as an important pathogen in patients with compromised immunity, leading to severe infections that are difficult to treat. Based on in vitro synergy studied, we recommend considering ticarcillin/clavulanate plus aztreonam as a potential treatment option in immunocompromised patients with S. maltophilia infection.
Authors:
Nathan P Downhour; Eskild A Petersen; Todd S Krueger; Krishnarao V Tangella; David E Nix
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  36     ISSN:  1060-0280     ISO Abbreviation:  Ann Pharmacother     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-01-30     Completed Date:  2002-07-12     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  63-6     Citation Subset:  IM    
Affiliation:
Infectious Diseases Section, Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.
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MeSH Terms
Descriptor/Qualifier:
Anti-Bacterial Agents / therapeutic use
Aztreonam / therapeutic use
Bone Marrow Transplantation / adverse effects
Cellulitis / drug therapy,  microbiology*
Clavulanic Acid / therapeutic use
Drug Therapy, Combination / therapeutic use
Gram-Negative Bacterial Infections / drug therapy,  microbiology*
Humans
Male
Middle Aged
Monobactams / therapeutic use
Muscle, Skeletal / microbiology,  surgery
Myositis / drug therapy,  microbiology*
Penicillins / therapeutic use
Risk Factors
Stenotrophomonas maltophilia*
Ticarcillin / therapeutic use
Trimethoprim-Sulfamethoxazole Combination / therapeutic use
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Monobactams; 0/Penicillins; 34787-01-4/Ticarcillin; 58001-44-8/Clavulanic Acid; 78110-38-0/Aztreonam; 8064-90-2/Trimethoprim-Sulfamethoxazole Combination

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


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