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Stenotrophomonas maltophilia , an emerging opportunistic pathogen, is widely distributed in the environment the resistance mechanisms, and virulence factors of this bacterium facilitate its dissemination in hospitals. This study aimed to characterize the molecular epidemiology of  S. maltophilia  strains associated with an outbreak in the Children's Hospital of México Federico Gómez (HIMFG). Twenty-one clinical  S. maltophilia  strains were recovered from cultures of blood and urine samples from 10 pediatric patients at the emergency department, and nine environmental  S. maltophilia  strains recovered from faucets in the same area were also included. Two of the 10 patients were related with health care-associated infections (HCAIs), and the other eight patients (8/10) were infected with environmental  S. maltophilia  strains. The outbreak was controlled by monthly disinfection of the faucets in the emergency department. Typing using pulsed-field gel electrophoresis (PFGE) showed a 52% genetic diversity with seven pulsotypes denoted P1–P7 among all  S. maltophilia  strains. Three pulsotypes (P2, P3, and P7) were identified among both the clinical and environmental  S. maltophilia  strains and associated with two type sequences (STs), namely, ST304 and ST24. Moreover, 80% (24/30) of the strains exhibited resistance mainly to tetracycline, 76.66% (23/30) to trimethoprim-sulfamethoxazole, and 23.33% (7/30) to the extended-spectrum β-lactamase (ESBL) phenotype. The main resistance genes identified by multiplex PCR were  sul1  in 100% (30/30),  qnr  in 86.66% (26/30), and  intl1  in 80% (24/30) of the samples, respectively. Furthermore, the  pilU, hlylII , and  rmlA  genes were identified in 96.6% (29/30), 90% (27/30), and 83.33% (25/30) of the samples, respectively. Additionally, 76.66% (23/30) of the  S. maltophilia  strains exhibited high swimming motility, 46.66% (14/30) showed moderate biofilm formation capacity, 43.33% (13/30) displayed moderate twitching motility, and 20% (6/30) exhibited high adherence. The clinical  S. maltophilia  strains isolated from blood most strongly adhered to HTB-9 cells. In conclusion, the molecular epidemiology and some of the features such as resistance, and virulence genes associated with colonization patterns are pathogenic attributes that can promote  S. maltophilia  dissemination, persistence, and facilitate the outbreak that occurred in the HIMFG. This study supports the need for faucet disinfection as a control strategy for clinical outbreaks.

frontiers in cellular and infection microbiology

Molecular Epidemiology, Antibiotic Resistance, and Virulence Traits of Stenotrophomonas maltophilia Strains Associated With an Outbreak in a Mexican Tertiary Care Hospital