JAC Advance Access published online on February 18, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh128
© 2004 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Infectious
Diseases, University of São Paulo Medical School;
* Corresponding author. E-mail: acnicodemo{at}uol.com.br.
Received 21 October 2003
; revised 24 December 2003
; accepted 28 December 2003
The disc diffusion, Etest and agar dilution techniques
were compared to evaluate the antimicrobial susceptibility profile
of 70 Stenotrophomonas maltophilia isolates to
seven antimicrobial agents. The S. maltophilia isolates
were consecutively collected from May 2000 to May 2002 from individual
patients, who were hospitalized in a private Brazilian hospital.
The antimicrobial susceptibility tests were carried out and interpreted according
to the National Committee for Clinical Laboratory Standards (NCCLS)
recommendations. The Etest was carried out according to the manufacturer’s
instructions. There was good agreement among the distinct
susceptibility testing results for chloramphenicol, doxycycline,
gatifloxacin, trimethoprim-sulfamethoxazole and ticarcillin-clavulanate,
suggesting that the disc diffusion and Etest methods are reliable for
testing this group of antimicrobials against S. maltophilia.
In contrast, a weak correlation was found between the disc diffusion
and agar dilution techniques for testing polymyxin B and colistin
with unacceptable very major error rates (18.1% and 22.7% for
polymyxin B and colistin, respectively). Trimethoprim-
sulfamethoxazole (MIC50, 0.06 mg/L; 98.5% susceptible)
and gatifloxacin (MIC50, 0.12 mg/L; 98.5% susceptible)
were the most potent antimicrobial agents tested against S.
maltophilia isolates. In contrast, the worst
in vitro activity was found for ticarcillin-clavulanate
(MIC50, 16 mg/L; 59.1% susceptible). Although
our results confirm that trimethoprim-sulfamethoxazole,
gatifloxacin and doxycycline have an excellent in vitro activity
against S. maltophilia, further clinical studies
are necessary to evaluate the clinical efficacy of these compounds
for the treatment of S. maltophilia infections,
since no randomized controlled trials have been carried out and
no correlation between the clinical response and susceptibility
testing results has been reported.
Keywords: susceptibility testing, drug resistance, S.
maltophilia
In vitro susceptibility of Stenotrophomonas
maltophilia isolates: comparison of disc diffusion, Etest and
agar dilution methods
2 Hospital Sírio Libanês;
3 Division of Infectious Diseases,
Federal University of São Paulo, São Paulo, S.P.,
Brazil
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