Emerging lower respiratory infections caused by Stenotrophomonas maltophilia among debilitated patients with endotracheal tubes or Cystic fibrosis

Stenotrophomonas maltophilia is considered an environmental bacterium, although ilittle is known of its epidemiology. Even less is known of pathogenic mechanisms and virulence factors. This reflects over difficulties in distinguishing colonization from true infection, which has fostered the view that the bacterium is essentially non-pathogenic. In the last decade S.maltophilia has been documented as an important agent of nosocomial infections, mainly in debilitated individuals with mortality rate 26,7%. Many strains of the bacterium manifest resistance to multiple antibiotics.This study is generally case report of unusual isolation of Stenotrophomonas maltophilia originated from medical devices (endotracheal tubes) used to support immunosuppressed surgical patients in KARIL as well as patient with CF and attempt to distinguish colonization from infection. During our continuous monitoring procedure, we have isolated 26 multi-drug resistant strains of Stenotrophomonas maltophilia (100% resistance to cefixime, ceftriakson, cefuroxime,cefotaxim, amoxicillin + clavulanic acid, imipenem). Automatic VITEK technique has been used for identification as well as for antibiotic susceptibility testing, to confirm traditional microbiological techniques (morphology of colonies on blood agar plates and negative oxidase test, disk-diffusion method and E-test). All patients suffered from traumatic hemorrhagic shock syndrome. Clinical significance has been confirmed in 4 cases from intubated patients with clinical signs for lower respiratory infection (high body temperature 38,5C, and Ro confirmation). These patients have been treated with Klimicin and Lendacin with recovering period in 4 days. There were no clinical signs patient with cystic fibrosis. Key words: Steotrophomonas maltophilia, lower respiratory infections, clinical significance,endotracheal tube, C