{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T03:39:54Z","timestamp":1785901194460,"version":"3.56.0"},"reference-count":180,"publisher":"Akademiai Kiado Zrt.","issue":"2","funder":[{"name":"Thailand Science Research and Innovation (TSRI), Chulabhorn Research Institute","award":["53500\/4821855"],"award-info":[{"award-number":["53500\/4821855"]}]}],"content-domain":{"domain":["www.akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMICR"],"published-print":{"date-parts":[[2026,5,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Stenotrophomonas maltophilia<\/jats:italic>\n                    is an opportunistic pathogen primarily associated with hospital-acquired infections, particularly in individuals who are immunocompromised.\n                    <jats:italic>S. maltophilia<\/jats:italic>\n                    infections pose a significant clinical challenge due to the bacterium's sophisticated intrinsic and acquired mechanisms, which render it naturally multidrug resistant. The management of such infections is thus difficult, as the availability of effective therapeutic agents is limited. Antibiotic therapy options include co-trimoxazole, minocycline, tigecycline, levofloxacin, cefiderocol, and ceftazidime-avibactam. Co-trimoxazole, which comprises a synergistic combination of trimethoprim and sulfamethoxazole, remains the recommended first-line therapy for\n                    <jats:italic>S. maltophilia<\/jats:italic>\n                    infections. In this review, we critically evaluate the current evidence on the efficacy of co-trimoxazole against\n                    <jats:italic>S. maltophilia<\/jats:italic>\n                    . The present global prevalence of co-trimoxazole resistance in\n                    <jats:italic>S. maltophilia<\/jats:italic>\n                    clinical isolates varies from &lt;5% to approximately 44%, raising concerns about its long-term reliability. Resistance to co-trimoxazole arises through several mechanisms. Horizontal\u00a0gene transfer can introduce\n                    <jats:italic>sul<\/jats:italic>\n                    genes, which encode sulfonamide-insensitive dihydropteroate synthase, or\n                    <jats:italic>dfrA<\/jats:italic>\n                    genes, which encode trimethoprim-insensitive dihydrofolate reductase. Both\u00a0enzymes function within the folate biosynthesis pathway, and their expression directly confers co-trimoxazole resistance.\n                    <jats:italic>S. maltophilia<\/jats:italic>\n                    can also acquire co-trimoxazole resistance through genetic mutations. The\u00a0overexpression of efflux systems such as SmeVWX and SmeDEF, contributes to high-level resistance\u00a0to co-trimoxazole, often triggered by mutations in the transcriptional regulators. Resistant strains frequently emerge due to improper antimicrobial use, as environmental antibiotic residues can act as selection pressure, facilitating the emergence and persistence of resistant strains. Despite these challenges, co-trimoxazole continues to demonstrate substantial clinical utility. It remains effective in many settings, either as monotherapy or in combination with other antibiotics such as minocycline, tigecycline, cefiderocol, or levofloxacin, and often achieves favorable outcomes.\n                  <\/jats:p>","DOI":"10.1556\/030.2026.02883","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T13:37:49Z","timestamp":1774013869000},"page":"119-130","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":2,"title":["Stenotrophomonas maltophilia infections: Current status on first-line therapy and other treatment options"],"prefix":"10.1556","volume":"73","author":[{"given":"Nisanart","family":"Charoenlap","sequence":"first","affiliation":[{"name":"Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok 10210, Thailand"},{"name":"Center of Excellence on Environmental Health and Toxicology (EHT), Office of the Permanent Secretary (OPS), Ministry of Higher Education, Science, Research and Innovation (MHESI), Bangkok 10400, Thailand"},{"name":"Program in Applied Biological Sciences: Environmental Health, Chulabhorn Graduate Institute, Bangkok 10210, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suleepon","family":"Poomchuchit","sequence":"additional","affiliation":[{"name":"Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok 10210, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Skorn","family":"Mongkolsuk","sequence":"additional","affiliation":[{"name":"Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok 10210, Thailand"},{"name":"Center of Excellence on Environmental Health and Toxicology (EHT), Office of the Permanent Secretary (OPS), Ministry of Higher Education, Science, Research and Innovation (MHESI), Bangkok 10400, Thailand"},{"name":"Program in Applied Biological Sciences: Environmental Health, Chulabhorn Graduate Institute, Bangkok 10210, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8744-4963","authenticated-orcid":true,"given":"Paiboon","family":"Vattanaviboon","sequence":"additional","affiliation":[{"name":"Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok 10210, Thailand"},{"name":"Center of Excellence on Environmental Health and Toxicology (EHT), Office of the Permanent Secretary (OPS), Ministry of Higher Education, Science, Research and Innovation (MHESI), Bangkok 10400, Thailand"},{"name":"Program in Applied Biological Sciences: Environmental Health, Chulabhorn Graduate Institute, Bangkok 10210, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"key":"B1","series-title":"Clin Microbiol Rev","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1128\/CMR.00019-11","article-title":"Stenotrophomonas maltophilia: an emerging global opportunistic pathogen","volume":"25","author":"Brooke JS","year":"2012","unstructured":"Brooke JS. 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