# Clonal spread of trimethoprim-sulfamethoxazole–resistant Stenotrophomonas maltophilia isolates in a tertiary hospital

## TL;DR

This study found that trimethoprim-sulfamethoxazole-resistant Stenotrophomonas maltophilia isolates in a hospital are clonally related, suggesting possible cross-transmission.

## Contribution

The study identifies clonally related S. maltophilia isolates and links sul1 gene in class 1 integrons to trimethoprim-sulfamethoxazole resistance.

## Key findings

- Trimethoprim-sulfamethoxazole resistance in S. maltophilia is associated with the presence of sul1 and intI1 genes.
- Twenty-four isolates were clonally related, with five trimethoprim-sulfamethoxazole-resistant isolates sharing a common clone.
- No environmental source of S. maltophilia was identified despite clonal spread among patients.

## Abstract

The aims of this study were to: (i) determine antibiotic susceptibility of clinical Stenotrophomonas maltophilia isolates, (ii) investigate the presence of different classes of integrons and sul genes responsible for sulphonamide resistance, (iii) assess the molecular epidemiology of the isolates by determining their clonal relatedness, and (iv) investigate the potential sources of infection by collecting environmental samples when necessary.

99 S. maltophilia isolates from clinical specimens of hospitalized patients were screened by PCR for sul1, sul2, sul3 genes, and integron-associated integrase genes: intI1, intI2, and intI3. PFGE was used to determine the clonal relatedness of the isolates.

Susceptibility rates for trimethoprim-sulfamethoxazole, levofloxacin, and ceftazidime were 90.9%, 91.9%, and 53.5% respectively. All trimethoprim-sulfamethoxazole–resistant isolates were positive for intI1 and sul1. PFGE analysis revealed that 24 of the isolates were clonally related, clustering in seven different clones. Five of the nine trimethoprim-sulfamethoxazole–resistant isolates were clonally related. The first isolate in this clone was from a wound sample of a patient in the infectious diseases clinic, and the other four were isolated from the bronchoalveolar lavage samples of patients in the thoracic surgery unit. The patient with the first isolate neither underwent bronchoscopy nor stayed in the thoracic surgery unit. Although clustering was observed in bronchoalveolar lavage samples, no S. maltophilia growth was detected in environmental samples.

The findings demonstrated that the sul1 gene carried by class 1 integrons plays an important role in trimethoprim-sulfamethoxazole resistance in S. maltophilia isolates. PFGE analysis revealed a high degree of genetic diversity. However, detection of clonally related isolates suggests the acquisition from a common source and/or cross-transmission of this microorganism between the patients.