Stenotrophomonas maltophilia在醫療照護相關感染及社區感染的重要性

The Role of Stenotrophomonas maltophilia in Healthcare-associated and Communityacquired Infections

Stenotrophomonas maltophilia(S. maltophilia)是非發酵性革蘭氏陰性桿菌，儘管它以往被視為低致病性的細菌，但已經有報導顯示在免疫不全的病人中 可導致顯著的致病率及死亡率。因天生就對許多廣效的抗生素具抗藥性，包括對Carbapenems類，使得它的治療變得複雜。近年來，許多文獻已經闡明S. maltophilia感染的危險因子，包括：白血球低下、中央靜脈導管留置、延長住院、先前使用過廣效抗生素等。然而感染S. maltophilia後的臨床預後，以及最適當的治療共識都尚未被釐清及建立。此外，除了醫療照護相關感染外，也逐漸有社區型感染的文獻報告，這群病患大部分都具潛在性疾病或接受過特殊臨床處置，如：手術、創傷、惡性腫瘤、免疫缺失、醫療裝置的留置、曾使用過抗生素或住院的病史。因此，除了醫療照護相關感染外，S. maltophilia在社區感染的角色亦值得受到注意。

Stenotrophomonas maltophilia, a non-fermentative and gram-negative bacillus, plays an increasingly important role as a nosocomial pathogen in compromised patients, although it was previously considered to have limited pathogenicity. The treatment of S. maltophilia infections is complicated by its intrinsic resistance to many broad-spectrum antibiotics, including carbapenems. Recent studies have elucidated the risk factors for S. maltophilia infection, such as neutropenia, indwelling central venous catheters, prolonged hospitalization, and prior exposure to broad-spectrum antibiotics. However, the outcomes and optimal treatment for S. maltophilia infection are not clearly established. Studies have been conducted to evaluate community-acquired infection. Most patients have underlying comorbidities, such as surgery, trauma, malignancy, an immunocompromised status, an indwelling device, prior antibiotic use, or a history of hospitalization.