title: Endocarditis caused by Stenotrophomonas maltophilia: case report and review.
abstract: Stenotrophomonas (Xanthomonas) maltophilia is a rare cause of endocarditis. The extensive resistance of this organism to several antibiotics leaves few options for antimicrobial therapy. In vitro synergism of the combination of trimethoprim-sulfamethoxazole (TMP-SMZ) and ticarcillin/clavulanic acid (TIC/CA) has been demonstrated. To our knowledge, we report the first case of ventriculoatrial cerebrospinal fluid shunt-associated endocarditis due to S. maltophilia. The patient was cured with combination therapy with TMP-SMZ and TIC/CA along with catheter removal. This is also the first report of S. maltophilia endocarditis successfully treated with this antibiotic combination. In a review of the medical literature, only 16 cases of S. maltophilia endocarditis were found. Most patients were intravenous drug users (43.8%) or had either prosthetic heart valves (50%) or an indwelling vascular catheter (18.8%). Although S. maltophilia is usually considered a nosocomial pathogen, about one-half of the cases were community-acquired. Twelve of sixteen patients had left-sided endocarditis. Therapy with a combination of two or more antibiotics was employed in most cases. Seven patients had been given TMP-SMZ therapy, but none had been treated with TIC/CA before. One-half of the patients required cardiac surgery. The overall mortality rate was 33%. Although the optimal antibiotic treatment for S. maltophilia endocarditis remains unknown, the case reported herein reinforces in vitro findings that the combination of TMP-SMZ and TIC/CA may be effective therapy.
authors.affiliation: Servicio de Medicina Interna, Hospital de la Marina Baixa, Alicante, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Gutiérrez Rodero
authors.forename: M M
authors.initials: MM
authors.lastname: Masiá
authors.forename: J
authors.initials: J
authors.lastname: Cortés
authors.forename: V
authors.initials: V
authors.lastname: Ortiz de la Tabla
authors.forename: V
authors.initials: V
authors.lastname: Mainar
authors.forename: A
authors.initials: A
authors.lastname: Vilar
mesh_terms: D002969:Clavulanic Acids / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000494:pharmacology*; D004697:Endocarditis, Bacterial / Q000097:blood / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013982:Ticarcillin / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D017287:Ventriculoperitoneal Shunt; D014974:Xanthomonas / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D002969:Clavulanic Acids; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; C043215:ticarcillin-clavulanic acid; D013982:Ticarcillin