Risk factors and molecular mechanisms associated with trimethoprim-sulfamethoxazole resistance in Stenotrophomonas maltophilia in Mexico

Sandra Abril Herrera-Heredia, César Pezina-Cantú, Elvira Garza-González, Paola Bocanegra-Ibarias, Soraya Mendoza-Olazarán, Rayo Morfín-Otero, Adrián Camacho-Ortiz, Licet Villarreal-Treviño, Eduardo Rodríguez-Noriega, Laura Paláu-Davila, Héctor Jesús Maldonado-Garza, Samantha Flores-Treviño

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Abstract

PURPOSE: Stenotrophomonas maltophilia is a multidrug-resistant opportunistic pathogen causing an increasing number of nosocomial infections. Our aim was to evaluate the risk factors and mechanisms associated with trimethoprim-sulfamethoxazole (SXT) resistance in S. maltophilia infections in Mexico.

METHODOLOGY: Clinical isolates and patients' demographic and clinical data were collected from February 2007 to August 2015 in two tertiary-care hospitals in Mexico. Antimicrobial susceptibility and analysis of sul and SmeABC and SmeDEF efflux pump overexpression were performed in all isolates.Results/Key findings. In the 9-year period, 196 patients infected with S. maltophilia were identified. Most patients were male, and the mean age was 46.2 years. The mean Charlson score was 1.42, and the most frequent comorbidities were arterial hypertension (26.7 %), type 2 diabetes (21.2 %) and cerebral infarction (11.6 %). High drug resistance to meropenem (93.4 %), gentamicin (55.1 %), ceftazidime (52.3 %), cefotaxime (51.5 %), amikacin (42.3 %) and cefepime (32.1 %), and lower resistance to ciprofloxacin (26.0 %), SXT (25.0 %), chloramphenicol (14.3 %) and levofloxacin (2.6 %) were detected. SXT resistance was not associated with the sul genes. SmeABC overexpression was associated with gentamicin (P=0.001) and levofloxacin resistance (P=0.041), whereas SmeDEF overexpression was associated with ceftazidime resistance (P=0.003). Prolonged hospitalization (≥15 days) was an independent risk factor for SXT-resistant S. maltophilia infections (OR=3.05; 95 % CI=1.12-8.86; P=0.029).

CONCLUSION: Given the high SXT resistance rate, SXT is not an effective first-line therapy for our patients; instead, levofloxacin could be used as an appropriate therapeutic option against S. maltophilia infections.

Original languageEnglish
Pages (from-to)1102-1109
Number of pages8
JournalJournal of Medical Microbiology
Volume66
Issue number8
DOIs
Publication statusPublished - Aug 2017
Externally publishedYes

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Trimethoprim Resistance
Stenotrophomonas maltophilia
Sulfamethoxazole Drug Combination Trimethoprim
Mexico
Levofloxacin
Ceftazidime
meropenem
Gentamicins
Infection
Amikacin
Cefotaxime
Cerebral Infarction
Chloramphenicol
Tertiary Healthcare
Ciprofloxacin
Cross Infection
Drug Resistance
Tertiary Care Centers
Type 2 Diabetes Mellitus
Comorbidity

Cite this

Herrera-Heredia, S. A., Pezina-Cantú, C., Garza-González, E., Bocanegra-Ibarias, P., Mendoza-Olazarán, S., Morfín-Otero, R., ... Flores-Treviño, S. (2017). Risk factors and molecular mechanisms associated with trimethoprim-sulfamethoxazole resistance in Stenotrophomonas maltophilia in Mexico. Journal of Medical Microbiology, 66(8), 1102-1109. https://doi.org/10.1099/jmm.0.000550
Herrera-Heredia, Sandra Abril ; Pezina-Cantú, César ; Garza-González, Elvira ; Bocanegra-Ibarias, Paola ; Mendoza-Olazarán, Soraya ; Morfín-Otero, Rayo ; Camacho-Ortiz, Adrián ; Villarreal-Treviño, Licet ; Rodríguez-Noriega, Eduardo ; Paláu-Davila, Laura ; Maldonado-Garza, Héctor Jesús ; Flores-Treviño, Samantha. / Risk factors and molecular mechanisms associated with trimethoprim-sulfamethoxazole resistance in Stenotrophomonas maltophilia in Mexico. In: Journal of Medical Microbiology. 2017 ; Vol. 66, No. 8. pp. 1102-1109.
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title = "Risk factors and molecular mechanisms associated with trimethoprim-sulfamethoxazole resistance in Stenotrophomonas maltophilia in Mexico",
abstract = "PURPOSE: Stenotrophomonas maltophilia is a multidrug-resistant opportunistic pathogen causing an increasing number of nosocomial infections. Our aim was to evaluate the risk factors and mechanisms associated with trimethoprim-sulfamethoxazole (SXT) resistance in S. maltophilia infections in Mexico.METHODOLOGY: Clinical isolates and patients' demographic and clinical data were collected from February 2007 to August 2015 in two tertiary-care hospitals in Mexico. Antimicrobial susceptibility and analysis of sul and SmeABC and SmeDEF efflux pump overexpression were performed in all isolates.Results/Key findings. In the 9-year period, 196 patients infected with S. maltophilia were identified. Most patients were male, and the mean age was 46.2 years. The mean Charlson score was 1.42, and the most frequent comorbidities were arterial hypertension (26.7 {\%}), type 2 diabetes (21.2 {\%}) and cerebral infarction (11.6 {\%}). High drug resistance to meropenem (93.4 {\%}), gentamicin (55.1 {\%}), ceftazidime (52.3 {\%}), cefotaxime (51.5 {\%}), amikacin (42.3 {\%}) and cefepime (32.1 {\%}), and lower resistance to ciprofloxacin (26.0 {\%}), SXT (25.0 {\%}), chloramphenicol (14.3 {\%}) and levofloxacin (2.6 {\%}) were detected. SXT resistance was not associated with the sul genes. SmeABC overexpression was associated with gentamicin (P=0.001) and levofloxacin resistance (P=0.041), whereas SmeDEF overexpression was associated with ceftazidime resistance (P=0.003). Prolonged hospitalization (≥15 days) was an independent risk factor for SXT-resistant S. maltophilia infections (OR=3.05; 95 {\%} CI=1.12-8.86; P=0.029).CONCLUSION: Given the high SXT resistance rate, SXT is not an effective first-line therapy for our patients; instead, levofloxacin could be used as an appropriate therapeutic option against S. maltophilia infections.",
author = "Herrera-Heredia, {Sandra Abril} and C{\'e}sar Pezina-Cant{\'u} and Elvira Garza-Gonz{\'a}lez and Paola Bocanegra-Ibarias and Soraya Mendoza-Olazar{\'a}n and Rayo Morf{\'i}n-Otero and Adri{\'a}n Camacho-Ortiz and Licet Villarreal-Trevi{\~n}o and Eduardo Rodr{\'i}guez-Noriega and Laura Pal{\'a}u-Davila and Maldonado-Garza, {H{\'e}ctor Jes{\'u}s} and Samantha Flores-Trevi{\~n}o",
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language = "English",
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Herrera-Heredia, SA, Pezina-Cantú, C, Garza-González, E, Bocanegra-Ibarias, P, Mendoza-Olazarán, S, Morfín-Otero, R, Camacho-Ortiz, A, Villarreal-Treviño, L, Rodríguez-Noriega, E, Paláu-Davila, L, Maldonado-Garza, HJ & Flores-Treviño, S 2017, 'Risk factors and molecular mechanisms associated with trimethoprim-sulfamethoxazole resistance in Stenotrophomonas maltophilia in Mexico', Journal of Medical Microbiology, vol. 66, no. 8, pp. 1102-1109. https://doi.org/10.1099/jmm.0.000550

Risk factors and molecular mechanisms associated with trimethoprim-sulfamethoxazole resistance in Stenotrophomonas maltophilia in Mexico. / Herrera-Heredia, Sandra Abril; Pezina-Cantú, César; Garza-González, Elvira; Bocanegra-Ibarias, Paola; Mendoza-Olazarán, Soraya; Morfín-Otero, Rayo; Camacho-Ortiz, Adrián; Villarreal-Treviño, Licet; Rodríguez-Noriega, Eduardo; Paláu-Davila, Laura; Maldonado-Garza, Héctor Jesús; Flores-Treviño, Samantha.

In: Journal of Medical Microbiology, Vol. 66, No. 8, 08.2017, p. 1102-1109.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk factors and molecular mechanisms associated with trimethoprim-sulfamethoxazole resistance in Stenotrophomonas maltophilia in Mexico

AU - Herrera-Heredia, Sandra Abril

AU - Pezina-Cantú, César

AU - Garza-González, Elvira

AU - Bocanegra-Ibarias, Paola

AU - Mendoza-Olazarán, Soraya

AU - Morfín-Otero, Rayo

AU - Camacho-Ortiz, Adrián

AU - Villarreal-Treviño, Licet

AU - Rodríguez-Noriega, Eduardo

AU - Paláu-Davila, Laura

AU - Maldonado-Garza, Héctor Jesús

AU - Flores-Treviño, Samantha

PY - 2017/8

Y1 - 2017/8

N2 - PURPOSE: Stenotrophomonas maltophilia is a multidrug-resistant opportunistic pathogen causing an increasing number of nosocomial infections. Our aim was to evaluate the risk factors and mechanisms associated with trimethoprim-sulfamethoxazole (SXT) resistance in S. maltophilia infections in Mexico.METHODOLOGY: Clinical isolates and patients' demographic and clinical data were collected from February 2007 to August 2015 in two tertiary-care hospitals in Mexico. Antimicrobial susceptibility and analysis of sul and SmeABC and SmeDEF efflux pump overexpression were performed in all isolates.Results/Key findings. In the 9-year period, 196 patients infected with S. maltophilia were identified. Most patients were male, and the mean age was 46.2 years. The mean Charlson score was 1.42, and the most frequent comorbidities were arterial hypertension (26.7 %), type 2 diabetes (21.2 %) and cerebral infarction (11.6 %). High drug resistance to meropenem (93.4 %), gentamicin (55.1 %), ceftazidime (52.3 %), cefotaxime (51.5 %), amikacin (42.3 %) and cefepime (32.1 %), and lower resistance to ciprofloxacin (26.0 %), SXT (25.0 %), chloramphenicol (14.3 %) and levofloxacin (2.6 %) were detected. SXT resistance was not associated with the sul genes. SmeABC overexpression was associated with gentamicin (P=0.001) and levofloxacin resistance (P=0.041), whereas SmeDEF overexpression was associated with ceftazidime resistance (P=0.003). Prolonged hospitalization (≥15 days) was an independent risk factor for SXT-resistant S. maltophilia infections (OR=3.05; 95 % CI=1.12-8.86; P=0.029).CONCLUSION: Given the high SXT resistance rate, SXT is not an effective first-line therapy for our patients; instead, levofloxacin could be used as an appropriate therapeutic option against S. maltophilia infections.

AB - PURPOSE: Stenotrophomonas maltophilia is a multidrug-resistant opportunistic pathogen causing an increasing number of nosocomial infections. Our aim was to evaluate the risk factors and mechanisms associated with trimethoprim-sulfamethoxazole (SXT) resistance in S. maltophilia infections in Mexico.METHODOLOGY: Clinical isolates and patients' demographic and clinical data were collected from February 2007 to August 2015 in two tertiary-care hospitals in Mexico. Antimicrobial susceptibility and analysis of sul and SmeABC and SmeDEF efflux pump overexpression were performed in all isolates.Results/Key findings. In the 9-year period, 196 patients infected with S. maltophilia were identified. Most patients were male, and the mean age was 46.2 years. The mean Charlson score was 1.42, and the most frequent comorbidities were arterial hypertension (26.7 %), type 2 diabetes (21.2 %) and cerebral infarction (11.6 %). High drug resistance to meropenem (93.4 %), gentamicin (55.1 %), ceftazidime (52.3 %), cefotaxime (51.5 %), amikacin (42.3 %) and cefepime (32.1 %), and lower resistance to ciprofloxacin (26.0 %), SXT (25.0 %), chloramphenicol (14.3 %) and levofloxacin (2.6 %) were detected. SXT resistance was not associated with the sul genes. SmeABC overexpression was associated with gentamicin (P=0.001) and levofloxacin resistance (P=0.041), whereas SmeDEF overexpression was associated with ceftazidime resistance (P=0.003). Prolonged hospitalization (≥15 days) was an independent risk factor for SXT-resistant S. maltophilia infections (OR=3.05; 95 % CI=1.12-8.86; P=0.029).CONCLUSION: Given the high SXT resistance rate, SXT is not an effective first-line therapy for our patients; instead, levofloxacin could be used as an appropriate therapeutic option against S. maltophilia infections.

U2 - 10.1099/jmm.0.000550

DO - 10.1099/jmm.0.000550

M3 - Article

C2 - 28771141

VL - 66

SP - 1102

EP - 1109

JO - Journal of Medical Microbiology

JF - Journal of Medical Microbiology

SN - 0022-2615

IS - 8

ER -