Stenotrophomonas maltophilia as an Emerging Ubiquitous Pathogen: Looking Beyond Contemporary Antibiotic Therapy.
Stenotrophomonas maltophilia as an Emerging Ubiquitous Pathogen: Looking Beyond Contemporary Antibiotic Therapy.
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DOI：
10.3389/fmicb.2017.02276
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发表时间：
2017
影响因子：
5.2
通讯作者：
Okoh AI
中科院分区：
文献类型：
--
作者：
Adegoke AA;Stenström TA;Okoh AI
嗜麦芽窄食单胞菌是一种常见的新出现的病原体，早期在易感人群的广谱威胁生命的感染中发现，但最近作为一种病原体出现在具有免疫能力的个人中。这种细菌一直与坏死性中耳炎、皮肤感染(包括软组织感染和角膜炎)、心内膜炎、脑膜炎、急性呼吸道感染(RTI)、菌血症(伴有或不伴有血液系统恶性肿瘤)、热带化脓性肌炎、囊性纤维化、感染性关节炎等有关。嗜麦芽窄食杆菌也是一种环境细菌，存在于水、根际、作为动物微生物区系的一部分、食品和其他几种微生物群中。这篇综述重点介绍了嗜麦芽窄食单胞菌作为一种机会性的和真正的病原体的临床报道。此外，还考虑了生物膜的形成以及群体感应、胞外酶、鞭毛、菌毛/菌毛、小菌落变异、其他毒力或毒力相关因素、抗生素耐药性因素及其意义。外膜通透性低、自然的多药耐药外排系统和/或耐药基因、耐药机制，如产生两种可诱导的染色体编码的β-内酰胺酶，以及缺乏精心编制的病史，这些因素对嗜麦芽窄食单胞菌的控制库构成了巨大的挑战。氟喹诺酮类、一些四环素类药物和甲氧苄氨嘧磺胺(TMP-SMX)被报道为有效的抗生素，治疗效果良好。然而，TMP-SMX的耐药性和对磺胺类药物的过敏以及氟喹诺酮的高毒性是值得注意的挫折。嗜麦芽窄食单胞菌通过群体感应产生和维持生物膜，提高了它们的毒力、对抗生素的耐药性和基因转移，使群体猝灭成为控制营养狭窄性单胞菌的必要步骤。结合其他几种成熟的方法，如生物工程噬菌体疗法、表没食子儿茶素没食子酸酯(EGCG)、精油、纳米乳液和阳离子化合物的使用，都是很有希望的替代方案，可以被纳入到营养单胞菌的控制武器库中。
Stenotrophomonas maltophilia is a commensal and an emerging pathogen earlier noted in broad-spectrum life threatening infections among the vulnerable, but more recently as a pathogen in immunocompetent individuals. The bacteria are consistently being implicated in necrotizing otitis, cutaneous infections including soft tissue infection and keratitis, endocarditis, meningitis, acute respiratory tract infection (RTI), bacteraemia (with/without hematological malignancies), tropical pyomyositis, cystic fibrosis, septic arthritis, among others. S. maltophilia is also an environmental bacteria occurring in water, rhizospheres, as part of the animals' microflora, in foods, and several other microbiota. This review highlights clinical reports on S. maltophilia both as an opportunistic and as true pathogen. Also, biofilm formation as well as quorum sensing, extracellular enzymes, flagella, pili/fimbriae, small colony variant, other virulence or virulence-associated factors, the antibiotic resistance factors, and their implications are considered. Low outer membrane permeability, natural MDR efflux systems, and/or resistance genes, resistance mechanisms like the production of two inducible chromosomally encoded β-lactamases, and lack of carefully compiled patient history are factors that pose great challenges to the S. maltophilia control arsenals. The fluoroquinolone, some tetracycline derivatives and trimethoprim-sulphamethaxole (TMP-SMX) were reported as effective antibiotics with good therapeutic outcome. However, TMP-SMX resistance and allergies to sulfa together with high toxicity of fluoroquinolone are notable setbacks. S. maltophilia's production and sustenance of biofilm by quorum sensing enhance their virulence, resistance to antibiotics and gene transfer, making quorum quenching an imperative step in Stenotrophomonas control. Incorporating several other proven approaches like bioengineered bacteriophage therapy, Epigallocatechin-3-gallate (EGCG), essential oil, nanoemulsions, and use of cationic compounds are promising alternatives which can be incorporated in Stenotrophomonas control arsenal.