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Abstract
Although trimethoprim-sulfamethoxazole (TMP-SXT) is considered the first-line therapy for Stenotrophomonas maltophilia infections, there is debate on the use of the bacteriostatic drug in serious infections, and recently, there has been an increasing occurrence of acquired resistance to TMP-SXT. In the present study, the effect of efflux pump inhibitors on the susceptibility of TMP-SXT and other antibiotics were investigated in S. maltophilia complex. The sul and/or dfr A genes were identified in only up to 27.8% of all 36 TMP-SXT-resistant S. maltophilia complex isolates. Thus, TMP-SXT resistance in S. maltophilia was not explained completely by the presence of sul and dfr A genes. Carbonyl cyanide-m-chlorophenylhydrazone (CCCP) decreased the minimum inhibitory concentration (MIC) of TMP-SXT by eight to 128 folds in all 14 isolates. In contrast, 2,4-dinitrophenol (DNP), phenyl-arginine-β-naphthylamide (PAβN), and reserpine did not reduce the MIC of TMP-SXT. In addition to TMP-SXT, slight decrease in MICs was observed for tigecycline and piperacillin/tazobactam by CCCP (by two folds) in one isolate. Although efflux pump may play a role in TMP-SXT resistance in S. maltophilia, inhibition of the efflux pump could be done by active proton pore.
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Table 1.
Oligonucleotide primers used in detecting sul1, sul2, and dfr A genes
Table 2.
Distribution of sul1 and dfrA genes in TMP-SXT-resistant isolates
Table 3.
Trimethoprim-sulfamethoxazole MICs of Stenotrophomonas maltophilia complex in treating with efflux pump inhibitors including CCCP and PAβN
Table 4.
Trimethoprim-sulfamethoxazole MICs of Trimethoprim-sulfamethoxazole resistant strains in treating with efflux pump inhibitors
Table 5.
MICs of a trimethoprim-sulfamethoxazole resistant strain K01-OTH-06-119 and K01-OTH-06-167 in treating with efflux pump inhibitors
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