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Abstract
Stenotrophomonas maltophilia is a multi-drug resistant pathogen that has been isolated with increasing frequency from the hospitalized patients. A total of 202 S. maltophilia was isolated from three university hospitals and analysed by molecular typing for an epidemiologic investigation. All isolates were tested by antimicrobial susceptibility, random amplified polymorphic DNA (RAPD) analysis, and pulsed-field gel electrophoresis (PFGE). The RAPD and PFGE patterns were recorded and analysed by the unweighted-pair group method with arithmetic average method. Two or more isolates were considered to be clonally related if their PFGE pattern exhibited ≥80% similarity. Trimethoprim/sulfamethoxazole and ciprofloxacin were the most active antimicrobial agents tested. The majority of the isolates found to be genetically unrelated by PFGE. The genetically related isolates were recovered from the same patient. The result demonstrates a high genetic diversity of S. maltophilia isolates from clinical specimens. The clonal diversity of S. maltophilia from the hospitalized patients is partly due to the strains originated from the hospital environments, but not horizontal transfer between the patients.
References
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Figure 1.
Resistance of S. maltophilia isolates against 18 antimicrobial agents. The lowest resistance rate of S. maltophilia isolates were for Cip, Cm, and Tp/Su, however, more than 90 % of isolates were resistant to Ap, Cx, Az, and Ip. Abbreviations: Tp: trimethoprim, Su: sulfamethoxazole, Km: kanamycin, Gm: gentamicin, Tb: tobramycin, Sm: streptomycin, Ak: amikacin, Ap: ampicillin, Ap/sul: ampicillin/sulbactam, Pi: piperacillin. Cx: cefoxitin, Ct: cefotaxime, Cd: ceftazidime, Az: aztreonam, Ip: imipenem, Cip: ciprofloxacin, Cm: chloramphenicol, Tc: tetracycline.
Figure 2.
PFGE XbaI profiles of S. maltophilia isolates. Lanes M: lambda ladder DNA, lane 1: S. maltophilia ATCC 13637, lane 2: 05KST01 (HHH), lane 3: 05KST03 (HHH), lane 4: 05KST11, lane 5: 05KST12, lane 6: 05KST19 (III), lane 7: 05KST23 (EEE), lane 8: 05KST25 (FFF), lane 9: 05KST27 (DDD), lane 10: 05KST28 (DDD), lane 11: 05KST32 (DDD), lane 12: 05KST33 (DDD), lane 13: 05KST36. Parenthesis next to the isolates number means the patient.
Figure 3.
Dendrogram of PFGE XbaI profiles of S. maltophilia isolates from clinical specimens. Profiles for similarity were performed with Gel Compar II software with Dice similarity indices (optimization, 3%). Dendrograms were generated by using the unweighted pair group method with arithmetic averages (UPGMA).
Figure 4.
DNA fingerprinting profiles of RAPD of S. maltophilia with 10 mer primer. Lanes M: DNA size marker (GeneRuler DNA Ladder Mix, MBI fermentas, Canada), lane 1: 05KST23 (EEE), lane 2: 05KST24 (EEE), lane 3: 05KST25 (FFF), lane 4: 05KST26, lane 5: 05KST27 (DDD), lane 6: 05KST28 (DDD), lane 7: 05KST29 (DDD), lane 8: 05KST30 (FFF), lane 9: 05KST31, lane 10: 05KST32 (DDD), lane 11: 05KST33 (DDD), lane 12: 05KST36. Parenthesis next to the isolates number means the patient.
Figure 5.
Dendrogram of S. maltophilia isolates from the same patients by RAPD (A) and PFGE (B). Fragments were analyzed using Dice similarity indices (optimization, 3%) and a dendrogram was drawn using unweighted-pair group method with arithmetic average (UPGMA).
Table 1.
S. maltophilia isolates from clinical specimens used in this study
| Area | Hospital | No. of isolates | Total | |
|---|---|---|---|---|
| 1994∼1998 | 2001∼2006 | |||
| Daegu | KY | 61 | 109 | 170 |
| DS | 6 | – | 6 | |
| Cheonan | DA | – | 26 | 26 |
Table 2.
Prevalence of S. maltophilia isolates according to clinical specimens
Table 3.
Characteristics of S. maltophilia multiply isolated from the same patient from 2004 to 2005
| Isolates No. | Patient | Date | Specimen | Same genotypea | Resistance patternb | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 04KST30 | AAA | Jul-04 | Sputum | Y / Y | Sm | Ap/sul | Km | Ct | Cx | Az | Cd | Pi | ||
| 04KST31 | AAA | Aug-04 | Bronchial aspirates | Y / Y | Sm | Ap/sul | Km | Ct | Cx | Az | Cd | Pi | ||
| 04KST01 | BBB | Apr-04 | Pus | Y / Y | Sm | Ap/sul | Ct | Cx | Az | Pi | ||||
| 04KST08 | BBB | May-04 | Pus | Y / N | Sm | Ap/sul | Gm | Cx | Az | Cd | Pi | |||
| 04KST10 | BBB | May-04 | Pus | Y / Y | Ap/sul | Az | Pi | |||||||
| 04KST02 | CCC | Apr-04 | Urine | N / N | Sm | Ap/sul | Tp/Su | Km | Gm | Ct | Az | Pi | ||
| 04KST04 | CCC | Apr-04 | Urine | N / N | Sm | Ap/sul | Gm | Ct | Cx | Az | Pi | |||
| 05KST27 | DDD | Jul-05 | Blood | Y / Y | Sm | Ap/sul | Ct | Az | Cd | Pi | ||||
| 05KST28 | DDD | Jul-05 | Blood | Y / Y | Ap/sul | Ct | Az | Cd | Pi | |||||
| 05KST29 | DDD | Jul-05 | Blood | Y / Y | Sm | Ap/sul | Ct | Cx | Az | Cd | Pi | |||
| 05KST32 | DDD | Jul-05 | Blood | Y / N | Ap/sul | Ct | Cx | Az | Cd | Pi | ||||
| 05KST33 | DDD | Jul-05 | Blood | Y / N | Ap/sul | Ct | Az | Pi | ||||||
| 05KST23 | EEE | Jun-05 | Sputum | Y / Y | Sm | Ap/sul | Km | Ct | Cx | Az | Cd | Pi | ||
| 05KST24 | EEE | Jun-05 | Sputum | Y / Y | Sm | Ap/sul | Km | Ct | Cx | Az | Pi | |||
| 04KST20 | GGG | Jul-04 | Pleural fluid | Y / Y | Sm | Km | ||||||||
| 04KST24 | GGG | Jul-04 | Pleural fluid | Y / Y | Sm | Km | ||||||||
| 05KST01 | HHH | Jan-05 | Pus | Y / Y | Sm | Ap/sul | Km | Ct | Az | Pi | ||||
| 05KST03 | HHH | Jan-05 | Pus | Y / Y | Sm | Ap/sul | Km | Gm | Ct | Az | ||||
| 05KST13 | HHH | Mar-05 | Sputum | N / N | Ap/sul | Tp/Su | Ct | Cx | Az | Pi | ||||
| 05KST19 | III | Jun-05 | Bile | Y / Y | Sm | Ap/sul | Km | Ct | Cx | Az | Cd | Pi | ||
| 05KST20 | III | Jun-05 | Blood | Y / Y | Sm | Ap/sul | Km | Ct | Cx | Az | Cd | Pi | ||
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