Stenotrophomonas

Question

Dear Expert Team,

My problem germs are mainly Staphylococcus, Haemophilus, sporadically Aspergillus, and currently also Stenotrophomonas. Over the past three weeks I have been feeling very sick and have had a lot of sputum and dry cough particularly at night, which has resulted in exhaustion and a high need for sleep.

My doctors are now focusing on the Stenotrophomonas because they assume it to be the reason for my current ailment. However, since the Stenotrophomonas is always subliminally present everywhere, could it not also be the other bacteria?

What I mean is that after the last antibiogram, only two antibiotics reacted positive to Stenotrophomonas. I tried Ciprofloxacine, which did not work, and Cefuroxime has not had a significant effect after the third day, either.

Whenever Stenotrophomonas has not been detected, I have been prescribed Doxycycline and it has helped me very well. Also, I was sometimes able to convince my doctors to prescribe Doxycycline when it was presumed resistant to the existing germs [translator’s comment: patient probably meant that the germs were presumed resistant to the antibiotic].

If you are dealing with patients who are already in their mid-40s, should you as a physician not trust the patients’ sense of what helps and what does not help, and at least try it? After all, an antibiogram only provides support with the choice of antibiotic but does not ensure success in its application.

As far as I know, Stenotrophomonas has not been researched enough to know what damage it does or does not cause. I was even advised to try an i.v. therapy, but with that, too, it is debatable whether it makes sense with this particular germ. I am almost ready to think about whether I will take this step, but I am also afraid of hospital germs.

Many thanks.

Answer

Good afternoon,

although I do not have enough information about you and your clinical condition to give a specific recommendation, I will nevertheless try to answer some of the questions you bring up.

You are right in saying that we do not know a lot about Stenotrophomonas yet, and we do have patients in whom we detect it time and again but who do not show corresponding clinical symptoms – but there are also patients who have the germ and show signs of inflammation as well as clinical symptoms. In that sense, it is hard to say which germ currently figures in your case and how to tackle it best. You are also correct in saying that both the antibiogram and the culture and detection of germs are one, but not the single decisive, parameter in therapy. After all, it is possible that the germ that is currently troubling you was not detectable in the sputum because other germs grew faster on the plate, or that it was only minimally present in the sputum.

Although Doxycycline is currently experiencing a certain renaissance, we use it with patients only rarely because most germs do not respond to it very well. You are certainly right in saying that, with 40 years’ worth of CF experience, you are well familiar with the disease, that you know yourself best, and that my colleagues and I should listen to the patients. An attempt at therapy does not do any harm if it worked for you, and you should talk to your doctors about it again.

If your health does not improve and your inflammation values are high (CRP), you should definitely consider an i.v. therapy, which you can do on an outpatient basis at least partly – that would help circumvent the risk of hospital germs.

I hope this helps a bit.

Best regards,
Prof. Dr. Joachim Baron

22.12.2008