Venous leg ulcers infected by Stenotrophomonas maltophilia

Stenotrophomonas maltophilia is a ubiquitous bacterium, aerobic, non-fermentative, belonging to the gram-negative group, closely linked to Pseudomonas species. It is the only species of Stenotrophomonas known to infect the human race and it is an opportunistic pathogen typical in the debilitated patients. The most common sites of infections by Stenotrophomonas Maltophilia are lungs, kidney, circulatory system and skin. Risk factors such as the use of broad-spectrum antibiotics, long periods of hospitalization, chemotherapy-induced neutropenia, parenteral nutrition increases the possibility of contracting the infectious process. A 48 years old man came to our attention at the outpatient clinic of the Phlebological Unit of Siena Hospital for the presence of venous ulcers and edema of lower legs. The patient has been suffering from leg ulcers for about ten years and he was followed in several hospitals in Tuscany region. The ulcers are revived after the discontinuation of antibiotic therapy. A bacterial culture was carried out at our microbiological laboratory and it highlighted the presence of Stenotrophomonas Maltophilia. Then after results of antibiotics susceptibility testing the therapy has been established with Trimethoprim/Sulfametoxazole two tablet die for three weeks. At the end, it was repeated the buffer with culture test that confirmed to be negative. The ulcer lesion of patient is currently in slow, but progressive increase. In our clinical experience this bacterium is a germ is expanding, since on 31 crop tests run in the last year this is already the second, equal to 6% of the total. If we look at the potential danger of this bacterium in patients with multiple illnesses, the elderly with complex drug therapies as are patients who come to our clinics we can see the need for a continuous monitoring of bacterial flora to prevent first evolution up to paintings by cellulitis, cutaneous necrosis and ectyma gangrenosum and mucocutaneous ulcers up to more serious forms like urinary tract infections, endocarditis, bacteremia, septicemia, meningitis. The prevention of infection with Stenotrophomonas maltophilia is very important and this can be achieved through the education of health personnel to prevent the transmission and spread of the bacterium, the regular cleaning and disinfection of medical instruments and surfaces, the routine handwashing protocol of Tuscany, the regular maintenance of hospital equipment and replacement of defective and worn parts, and the targeted use of antibiotics in order to limit antimicrobial resistance and the spread of the organism. Is therefore of particular importance an appropriate antibiotic selection and the establishment of surveillance systems in place to monitor possible contamination of the environment.