Cover Image

Antibiotic characteristics of clinical isolates of multi-drug resistant Stenotrophomonas maltophilia strains in the military hospital Vietnam

Thuy Thi Bich Vo, Son Thai Nguyen, Minh Ngoc Nghiem


Stenotrophomonas maltophilia (S. maltophilia) is its best known species because it is a globally emerging, multidrug-resistant (MDR), opportunistic pathogen. The aim of the study was to identify species in this collection, defined as genetically cohesive sequence clusters, and to determine the extent of their genetic, ecological and phenotypic differentiation. This framework was used to analyze 50 specimens for cultures were collected from patients in the military hospital in Hanoi, Vietnam, between 2015 and 2017. Three of the 30 MDR S. maltophilia isolates identified by Vitek technology in hospital were confirmed using 16S rRNA gene sequencing. The alignment sequences were analyzed in RAxML version 8.2.10 to estimate the best maximum likelihood phylogenetic tree, with 1,000 bootstrap replicates, estimated GTRGAMMA model and the rapid bootstrapping algorithm. Over 70% of S. maltophilia isolates were resistant to β-lactams (such as carbapenem, penicilline, monobactam, amoxicillin, cephem, and β-lactam); Aminoglycosides (such as gentamycine and tobramycin); Miscellaneous (such as fosfomycin and chloramphenicol). In particularly, all of this strain isolates were resistant to β-lactams and Aminoglycosides high annual increasing/ frequency from 2015 to 2017 year. Three resistant strains with most antibiotics (S. maltophilia 17-87M, 17-95M and 17-90N) were randomly selected to test the association between genotype and phenotypic resistance. The results were shown a significantly different in antibiotic genes expression among three strains and a few difference in phenotypic resistance. These data in light of current models of bacterial speciation, which fit these data well, are stressing the implications of species delimitation in ecological, evolutionary and clinical research.


Stenotrophomonas maltophilia; antimicrobial susceptibility; multidrug-resistant; 16S rRNA gene sequencing

Full Text:



Brooke JS. Stenotrophomonas maltophilia: An emerging global opportunistic pathogen. Clin Microbiol Rev. 2012, 25:2-41

Chang LL, Chen HF, Chang CY, Lee TM, Wu WJ. Contribution of integrons, and smeabc and smedef efflux pumps to multidrug resistance in clinical isolates of stenotrophomonas maltophilia. J Antimicrob Chemother. 2004, 53:518-21

Tan CK, Liaw SJ, Yu CJ, Teng LJ, Hsueh PR. Extensively drug-resistant stenotrophomonas maltophilia in a tertiary care hospital in taiwan: Microbiologic characteristics, clinical features, and outcomes. Diagn Microbiol Infect Dis. 2008, 60:205-10

Liu YM, Chen YS, Toh HS, Huang CC, Lee YL, Ho CM, Lu PL, Ko WC, Chen YH, Wang JH, Tang HJ, Yu KW, Liu YC, Chuang YC, Xu Y, Ni Y, Liu CE, Hsueh PR. In vitro susceptibilities of non-enterobacteriaceae isolates from patients with intra-abdominal infections in the asia-pacific region from 2003 to 2010: Results from the study for monitoring antimicrobial resistance trends (smart). Int J Antimicrob Agents. 2012, 40 Suppl:S11-7

Nicodemo AC, Paez JI. Antimicrobial therapy for stenotrophomonas maltophilia infections. Eur J Clin Microbiol Infect Dis. 2007, 26:229-37

Falagas ME, Kastoris AC, Vouloumanou EK, Dimopoulos G. Community-acquired stenotrophomonas maltophilia infections: A systematic review. Eur J Clin Microbiol Infect Dis. 2009, 28:719-30

Naidu P, Smith S. A review of 11 years of stenotrophomonas maltophilia blood isolates at a tertiary care institute in canada. Can J Infect Dis Med Microbiol. 2012, 23:165-9

Alonso A, Martinez JL. Multiple antibiotic resistance in stenotrophomonas maltophilia. Antimicrob Agents Chemother. 1997, 41:1140-2

Liaw SJ, Lee YL, Hsueh PR. Multidrug resistance in clinical isolates of stenotrophomonas maltophilia: Roles of integrons, efflux pumps, phosphoglucomutase (spgm), and melanin and biofilm formation. Int J Antimicrob Agents. 2010, 35:126-30

Yang Z, Liu W, Cui Q, Niu W, Li H, Zhao X, Wei X, Wang X, Huang S, Dong D, Lu S, Bai C, Li Y, Huang L, Yuan J. Prevalence and detection of stenotrophomonas maltophilia carrying metallo-beta-lactamase blal1 in beijing, china. Front Microbiol. 2014, 5:692

Araoka H, Baba M, Yoneyama A. Risk factors for mortality among patients with stenotrophomonas maltophilia bacteremia in tokyo, japan, 1996-2009. Eur J Clin Microbiol Infect Dis. 2010, 29:605-8

Enas AE-MD, Nahla ME, Amany GT, Ehsan MW. Multidrug resistant stenotrophomonas maltophilia: An emerging cause of hospital acquired infections in assiut university hospitals, egypt. International Journal of Infection Control. 2017, 13:1-13

Zhang L, Li XZ, Poole K. Multiple antibiotic resistance in stenotrophomonas maltophilia: Involvement of a multidrug efflux system. Antimicrob Agents Chemother. 2000, 44:287-93

Brooke JS. New strategies against stenotrophomonas maltophilia: A serious worldwide intrinsically drug-resistant opportunistic pathogen. Expert Rev Anti Infect Ther. 2014, 12:1-4

Looney WJ, Narita M, Muhlemann K. Stenotrophomonas maltophilia: An emerging opportunist human pathogen. Lancet Infect Dis. 2009, 9:312-23

Sanchez MB, Hernandez A, Martinez JL. Stenotrophomonas maltophilia drug resistance. Future Microbiol. 2009, 4:655-60

Gould VC, Okazaki A, Avison MB. Beta-lactam resistance and beta-lactamase expression in clinical stenotrophomonas maltophilia isolates having defined phylogenetic relationships. J Antimicrob Chemother. 2006, 57:199-203

Vinuesa P, Silva C, Werner D, Martinez-Romero E. Population genetics and phylogenetic inference in bacterial molecular systematics: The roles of migration and recombination in bradyrhizobium species cohesion and delineation. Mol Phylogenet Evol. 2005, 34:29-54

Xun M, Zhang Y, Li BL, Wu M, Zong Y, Yin YM. Clinical characteristics and risk factors of infections caused by stenotrophomonas maltophilia in a hospital in northwest china. J Infect Dev Ctries. 2014, 8:1000-5

Iván S-C, Ruiz-Fresneda MA, Bakkali M, Kämpfer P, Glaeser SP, Busse HJ, López-Fernández M, Martínez-Rodríguez P, Merroun ML. Stenotrophomonas bentonitica sp. Nov., isolated from bentonite formations. Int J Syst Evol Microbiol. 2017, 67:2779-2786

Falagas ME, Kastoris AC, Vouloumanou EK, Rafailidis PI, Kapaskelis AM, Dimopoulos G. Attributable mortality of stenotrophomonas maltophilia infections: A systematic review of the literature. Future Microbiol. 2009, 4:1103-9

Nayyar C, Thakur P, Tak V, Saigal K. Stenotrophomonas maltophilia: An emerging pathogen in paediatric population. J Clin Diagn Res. 2017, 11:DC08-DC11

Fihman V, Le Monnier A, Corvec S, Jaureguy F, Tankovic J, Jacquier H, Carbonnelle E, Bille E, Illiaquer M, Cattoir V, Zahar JR. Stenotrophomonas maltophilia--the most worrisome threat among unusual non-fermentative gram-negative bacilli from hospitalized patients: A prospective multicenter study. J Infect. 2012, 64:391-8

Lai CH, Chi CY, Chen HP, Chen TL, Lai CJ, Fung CP, Yu KW, Wong WW, Liu CY. Clinical characteristics and prognostic factors of patients with stenotrophomonas maltophilia bacteremia. J Microbiol Immunol Infect. 2004, 37:350-8

Valdezate S, Vindel A, Martin-Davila P, Del Saz BS, Baquero F, Canton R. High genetic diversity among stenotrophomonas maltophilia strains despite their originating at a single hospital. J Clin Microbiol. 2004, 42:693-9

Chung HS, Hong SG, Kim YR, Shin KS, Whang DH, Ahn JY, Park YJ, Uh Y, Chang CL, Shin JH, Lee HS, Lee K, Chong Y. Antimicrobial susceptibility of stenotrophomonas maltophilia isolates from korea, and the activity of antimicrobial combinations against the isolates. J Korean Med Sci. 2013, 28:62-6

Tanimoto K. Stenotrophomonas maltophilia strains isolated from a university hospital in japan: Genomic variability and antibiotic resistance. J Med Microbiol. 2013, 62:565-70

Juhasz E, Pongracz J, Ivan M, Kristof K. Antibiotic susceptibility of sulfamethoxazole-trimethoprim resistant stenotrophomonas maltophilia strains isolated at a tertiary care centre in hungary. Acta Microbiol Immunol Hung. 2015, 62:295-305

Bookstaver PB, Bland CM, Griffin B, Stover KR, Eiland LS, McLaughlin M. A review of antibiotic use in pregnancy. Pharmacotherapy. 2015, 35:1052-62

Kaase M, Nordmann P, Wichelhaus TA, Gatermann SG, Bonnin RA, Poirel L. Ndm-2 carbapenemase in acinetobacter baumannii from egypt. J Antimicrob Chemother. 2011, 66:1260-2

Samonis G, Karageorgopoulos DE, Maraki S, Levis P, Dimopoulou D, Spernovasilis NA, Kofteridis DP, Falagas ME. Stenotrophomonas maltophilia infections in a general hospital: Patient characteristics, antimicrobial susceptibility, and treatment outcome. PLoS One. 2012, 7:e37375

Cho SY, Lee DG, Choi SM, Park C, Chun HS, Park YJ, Choi JK, Lee HJ, Park SH, Choi JH, Yoo JH. Stenotrophomonas maltophilia bloodstream infection in patients with hematologic malignancies: A retrospective study and in vitro activities of antimicrobial combinations. BMC Infect Dis. 2015, 15:69

Karthikeyan K, Thirunarayan MA, Krishnan P. Coexistence of blaoxa-23 with blandm-1 and arma in clinical isolates of acinetobacter baumannii from india. J Antimicrob Chemother. 2010, 65:2253-4

Ewers C, Klotz P, Leidner U, Stamm I, Prenger-Berninghoff E, Gottig S, Semmler T, Scheufen S. Oxa-23 and isaba1-oxa-66 class d beta-lactamases in acinetobacter baumannii isolates from companion animals. Int J Antimicrob Agents. 2017, 49:37-44

Crossman LC, Gould VC, Dow JM, Vernikos GS, Okazaki A, Sebaihia M, Saunders D, Arrowsmith C, Carver T, Peters N, Adlem E, Kerhornou A, Lord A, Murphy L, Seeger K, Squares R, Rutter S, Quail MA, Rajandream MA, Harris D, Churcher C, Bentley SD, Parkhill J, Thomson NR, Avison MB. The complete genome, comparative and functional analysis of stenotrophomonas maltophilia reveals an organism heavily shielded by drug resistance determinants. Genome Biol. 2008, 9:R74

Gallo SW, Figueiredo TP, Bessa MC, Pagnussatti VE, Ferreira CA, Oliveira SD. Isolation and characterization of stenotrophomonas maltophilia isolates from a brazilian hospital. Microb Drug Resist. 2016, 22:688-695

Gould VC, Avison MB. Smedef-mediated antimicrobial drug resistance in stenotrophomonas maltophilia clinical isolates having defined phylogenetic relationships. J Antimicrob Chemother. 2006, 57:1070-6

Garcia-Leon G, Ruiz de Alegria Puig C, Garcia de la Fuente C, Martinez-Martinez L, Martinez JL, Sanchez MB. High-level quinolone resistance is associated with the overexpression of smevwx in stenotrophomonas maltophilia clinical isolates. Clin Microbiol Infect. 2015, 21:464-7

Cho HH, Sung JY, Kwon KC, Koo SH. Expression of sme efflux pumps and multilocus sequence typing in clinical isolates of stenotrophomonas maltophilia. Ann Lab Med. 2012, 32:38-43

Okazaki A, Avison MB. Aph(3')-iic, an aminoglycoside resistance determinant from stenotrophomonas maltophilia. Antimicrob Agents Chemother. 2007, 51:359-60

Li XZ, Zhang L, McKay GA, Poole K. Role of the acetyltransferase aac(6')-iz modifying enzyme in aminoglycoside resistance in stenotrophomonas maltophilia. J Antimicrob Chemother. 2003, 51:803-11

Tada T, Miyoshi-Akiyama T, Dahal RK, Mishra SK, Shimada K, Ohara H, Kirikae T, Pokhrel BM. Identification of a novel 6'-n-aminoglycoside acetyltransferase, aac(6')-iak, from a multidrug-resistant clinical isolate of stenotrophomonas maltophilia. Antimicrob Agents Chemother. 2014, 58:6324-7

Babaei M, Sulong A, Hamat R, Nordin S, Neela V. Extremely high prevalence of antiseptic resistant quaternary ammonium compound e gene among clinical isolates of multiple drug resistant acinetobacter baumannii in malaysia. Ann Clin Microbiol Antimicrob. 2015, 14:11

Smith K, Gemmell CG, Hunter IS. The association between biocide tolerance and the presence or absence of qac genes among hospital-acquired and community-acquired mrsa isolates. J Antimicrob Chemother. 2008, 61:78-84


  • There are currently no refbacks.

AJCMicrob (ISSN 2572-5815) Copyright © 2012-2020. All rights reserved. Published by Ivy Union Publishing, 3204 Valley Rush Dr, Apex, North Carolina 27502, United States