Severe cellulitis/myositis caused by Stenotrophomonas maltophilia

Nathan P. Downhour, Eskild A. Petersen, Todd S. Krueger, Krishnarao V. Tangella, David E. Nix

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

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 β-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.

Original languageEnglish (US)
Pages (from-to)63-66
Number of pages4
JournalAnnals of Pharmacotherapy
Volume36
Issue number1
StatePublished - 2002

Fingerprint

Stenotrophomonas maltophilia
Myositis
Cellulitis
Aztreonam
Clavulanic Acid
Sulfamethoxazole Drug Combination Trimethoprim
Ticarcillin
Infection
Wounds and Injuries
Immunocompromised Host
Microbial Sensitivity Tests
Neutropenia
Intensive Care Units
Immunity
Skeletal Muscle
Hospitalization
Bone Marrow
Anti-Bacterial Agents
Transplants
Muscles

Keywords

  • Aztreonam
  • Cellulitis
  • Stenotrophomonas maltophilia
  • Ticarcillin/clavulanate

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Downhour, N. P., Petersen, E. A., Krueger, T. S., Tangella, K. V., & Nix, D. E. (2002). Severe cellulitis/myositis caused by Stenotrophomonas maltophilia. Annals of Pharmacotherapy, 36(1), 63-66.

Severe cellulitis/myositis caused by Stenotrophomonas maltophilia. / Downhour, Nathan P.; Petersen, Eskild A.; Krueger, Todd S.; Tangella, Krishnarao V.; Nix, David E.

In: Annals of Pharmacotherapy, Vol. 36, No. 1, 2002, p. 63-66.

Research output: Contribution to journalArticle

Downhour, NP, Petersen, EA, Krueger, TS, Tangella, KV & Nix, DE 2002, 'Severe cellulitis/myositis caused by Stenotrophomonas maltophilia', Annals of Pharmacotherapy, vol. 36, no. 1, pp. 63-66.
Downhour NP, Petersen EA, Krueger TS, Tangella KV, Nix DE. Severe cellulitis/myositis caused by Stenotrophomonas maltophilia. Annals of Pharmacotherapy. 2002;36(1):63-66.
Downhour, Nathan P. ; Petersen, Eskild A. ; Krueger, Todd S. ; Tangella, Krishnarao V. ; Nix, David E. / Severe cellulitis/myositis caused by Stenotrophomonas maltophilia. In: Annals of Pharmacotherapy. 2002 ; Vol. 36, No. 1. pp. 63-66.
@article{e63e60b34591456088836997f4827e9d,
title = "Severe cellulitis/myositis caused by Stenotrophomonas maltophilia",
abstract = "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 β-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.",
keywords = "Aztreonam, Cellulitis, Stenotrophomonas maltophilia, Ticarcillin/clavulanate",
author = "Downhour, {Nathan P.} and Petersen, {Eskild A.} and Krueger, {Todd S.} and Tangella, {Krishnarao V.} and Nix, {David E.}",
year = "2002",
language = "English (US)",
volume = "36",
pages = "63--66",
journal = "Annals of Pharmacotherapy",
issn = "1060-0280",
publisher = "Harvey Whitney Books Company",
number = "1",

}

TY - JOUR

T1 - Severe cellulitis/myositis caused by Stenotrophomonas maltophilia

AU - Downhour, Nathan P.

AU - Petersen, Eskild A.

AU - Krueger, Todd S.

AU - Tangella, Krishnarao V.

AU - Nix, David E.

PY - 2002

Y1 - 2002

N2 - 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 β-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.

AB - 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 β-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.

KW - Aztreonam

KW - Cellulitis

KW - Stenotrophomonas maltophilia

KW - Ticarcillin/clavulanate

UR - http://www.scopus.com/inward/record.url?scp=0036140568&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036140568&partnerID=8YFLogxK

M3 - Article

C2 - 11816260

AN - SCOPUS:0036140568

VL - 36

SP - 63

EP - 66

JO - Annals of Pharmacotherapy

JF - Annals of Pharmacotherapy

SN - 1060-0280

IS - 1

ER -