Definition • Stenotrophomonas

maltophilia and species of the

Burkholderia cepacia complex (BCC) are
opportunistic gram-negative pathogens
that cause a variety of clinical infections
in various immunocompromised hosts
including individuals with host genetic
defects and individuals with weakened
immune systems. Epidemiology • S.
maltophilia has had increasing rates of
isolation worldwide and has caused
nosocomial infections associated with
medical equipment and solutions. It also
is known to cause invasive infections in
patients with cancer and has been
increasing in frequency in patients with
cystic fibrosis (CF). • BCC species have
caused nosocomial outbreaks associated
with contaminated solutions and can
cause significant morbidity and mortality
in patients with CF and chronic
granulomatous disease. Burkholderia
cenocepacia and Burkholderia
multivorans are two of the major species
that are found to cause disease in
patients with CF. Patient-topatient
transmission has been demonstrated in
patients with CF. Microbiology • S.
maltophilia and BCC spp. are gram-
negative aerobic bacteria that are motile.
• As free-living organisms, they reside in
a broad range of environments including
aquatic environments. • They are
catalase-positive, they do not ferment
glucose, and many BCC members are
oxidase-positive. • BCC spp. comprise a
number of phenotypically similar but
genotypically distinct species; currently
there are at least 20 species in the BCC. •
S. maltophilia is found worldwide and has
significant genetic diversity among
isolates. Diagnosis • Accurate diagnosis is
critical, as these pathogens have high
levels of intrinsic antibiotic resistance.
Newer methods have been used for
successful identification of both BCC
members and S. maltophilia including 16S
ribosomal RNA sequencing and matrix-
assisted desorption/ ionization time-of-
flight mass spectrometry. Therapy •
Given that both pathogens have high
levels of intrinsic resistance to antibiotics,
choice of antibiotics should be driven by
antibiotic susceptibility testing. •
Trimethoprim-sulfamethoxazole is the
preferred antibiotic for both S.
maltophilia and BCC, although resistance
 has been reported and is increasing in
certain areas. Combination therapy is
frequently used. • Fluoroquinolones such
as moxifloxacin show activity in S.
maltophilia, but resistance has been
reported during single-drug therapy. •
Other drugs that have been shown to
have in vitro and in vivo activity in both
pathogens include minocycline,
ceftazidime, and newer agents such as
ceftazidime-avibactam. Carbapenems
have activity in BCC, and ticarcillin-
clavulanate and ampicillin-sulbactam can
retain activity in S. maltophilia.
Prevention • Nosocomial outbreaks
require strict infection control measures
including isolation measures. •
Surveillance of hospital water supplies is
important f