{'fraction_non_alphanumeric': 0.031376064545047065, 'fraction_numerical': 0.01344688480502017, 'mean_word_length': 5.486918604651163, 'pattern_counts': {'":': 0, '<': 1, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Successful Treatment of Stenotrophomonas maltophilia Soft Tissue Infection with Tigecycline: a Case Report

Stenotrophomonas maltophilia is a nonfermentative, Gram-negative bacillus of increasing importance as a nosocomial pathogen. S. maltophilia has been implicated in a broad spectrum of clinical syndromes, including pneumonia, bloodstream infection, skin infections and surgical-site-related infections 1-4. S. maltophilia shares with other emerging multidrug-resistant Gram-negative organisms the ability to produce betalactamase enzymes involved in the hydrolysis of betalactam-based antibiotics, such as penicillins, cephalosporins and carbapenems. The treatment of nosocomial infections due to S. maltophilia is difficult and controversial 5. Trimethoprim-sulfamethoxazole (TMP-sMx) is the antimicrobial agent of choice, but it is bacteriostatic and increased resistance to this agent has been reported. in addition this pathogen is frequently associated with other multidrug resistant bacteria in the setting of polymicrobial infections. Tigecycline, a new semisynthetic glycylcycline, shows in vitro activity against S. maltophilia, but its efficacy in clinical settings is yet to be established 6. Here, we report a case of S. maltophilia surgical wound infection with surrounding soft tissue involvement which was successfully treated with tigecycline. A 17-year-old male was admitted to Emergency Department of our Hospital because of a compound fracture of his left tibia, rupture of femoral artery and wide soft tissues loss of the leg, due to a road accident. He underwent salvage combined surgery with reduction and osteosynthesis of fracture and arterial bypass. After 4 days, the patient developed fever (39.5°C), dehiscence of surgical incision with purulent drainage involving deep soft tissues of the leg. no evidence of muscle localization was found by computed tomography (CT) scan. Laboratory findings showed: hemoglobin 13.5 g/dl; white blood cells 12,500/mm3 with 80% of neutrophils; platelets, 170,000/mm3. Erythrocyte sedimentation rate was 52 mm/h (normal range, 0–30 mm/h), and his C-reactive protein concentration was 9.6 mg/dL (normal values 0.50 mg/dL). Liver and kidney function were normal. Empiric antibiotic treatment with piperacillintazobactam and teicoplanin was started; the patient also underwent hyperbaric oxygen therapy and surgical debridement of devitalized tissue from wound. Culture of the debridement material grew S. maltophilia susceptible to TMP-sMx (MiC<2 mg/mL) only. Thus, the patient started treatment with TMP-sMx (2 tablets of 160/800 mg 3 times daily), but after 4 days he developed an allergic rash. TMP-sMx was substituted with tigecycline (100 mg loading dose, then 50 mg every 12 hours). After 4 days of monotherapy with tigecycline, we observed a reduction in both fever and signs of local inflammation. This antibiotic was combined with cefepime (2 g i.v. twice daily) because of subsequent isolation of susceptible pseudomonas aeruginosa in the same site of infection. The combined antibiotic treatment was continued for 15 days and led to progressive resolution of local inflammation and microbiological eradication. S. maltophilia represents an emerging and difficult-to-treat nosocomial pathogen. The response to therapy is influenced by several factors, including the genotypic and phenotypic variability of S. maltophilia species, intrinsic resistance mechanisms, the ability to develop resistance during treatment and the lack of standardized susceptibility tests. in addition, in vitro findings cannot be translated into clinical practice because there are no randomized clinical trials which compare the efficacy of different antimicrobial regimens. The Clinical and Laboratory standards institute (CLsi) recommends the disk diffusion technique in order to establish the susceptibility of S. maltophilia to TMP-sMx, minocycline, and levofloxacin. Other agents may be used for therapy, but according to the CLsi, their performance has not been sufficiently studied to establish disk diffusion breakpoints 6. Tigecycline exhibits potent activity against a wide spectrum of bacteria, including methicillin-resistant Staphylococcus aureus, coagulase-negative staphylococci, penicillin-resistant Streptococcus pneumoniae, enterococcus faecium. Tigecycline has limited or no in vitro activity against p. aeruginosa, while the drug has been reported to be active in vitro against AcineREpRInt