The complete genome, comparative and functional analysis of Stenotrophomonas maltophilia reveals an organism heavily shielded by drug resistance determinants.

BACKGROUND: Stenotrophomonas maltophilia is a nosocomial opportunistic pathogen of the Xanthomonadaceae. The organism has been isolated from both clinical and soil environments in addition to the sputum of cystic fibrosis patients and the immunocompromised. Whilst relatively distant phylogenetically, the closest sequenced relatives of S. maltophilia are the plant pathogenic xanthomonads. RESULTS: The genome of the bacteremia-associated isolate S. maltophilia K279a is 4,851,126 bp and of high G+C content. The sequence reveals an organism with a remarkable capacity for drug and heavy metal resistance. In addition to a number of genes conferring resistance to antimicrobial drugs of different classes via alternative mechanisms, nine resistance-nodulation-division (RND)-type putative antimicrobial efflux systems are present. Functional genomic analysis confirms a role in drug resistance for several of the novel RND efflux pumps. S. maltophilia possesses potentially mobile regions of DNA and encodes a number of pili and fimbriae likely to be involved in adhesion and biofilm formation that may also contribute to increased antimicrobial drug resistance. CONCLUSION: The panoply of antimicrobial drug resistance genes and mobile genetic elements found suggests that the organism can act as a reservoir of antimicrobial drug resistance determinants in a clinical environment, which is an issue of considerable concern.

Spermatoceles in adults: when does size matter?

Spermatoceles are benign cystic dilations of the epididymis. Despite their relatively common occurrence, it is not clear why or when men want this lesion treated. We present a single institution series of men undergoing spermatocelectomy. We describe the clinical characteristics of men with these lesions and hypothesize that men with spermatoceles seek intervention when the lesion approximates the size of a testicle. The characteristics of 24 men who sought excision of symptomatic spermatoceles were reviewed. Specific characteristics included subject age, duration of diagnosis, symptom type, and symptom duration. Spermatoceles were characterized by size, sidedness, and associated findings. Simple descriptive statistics were used for analysis. The mean age of men seeking spermatocelectomy was 46 years. Most men (58%) sought surgery due to a combination of pain and sensation of mass. The mean duration of symptoms was 48 months. At the time of excision, the average size of spermatoceles was 4.2 cm in greatest diameter, and most (71%) were right sided. Men who experienced pain as an isolated symptom were younger by approximately 10 years compared to those who experienced mass. Men in this series appear to tolerate spermatoceles for a relatively long period of time. Once they seek excision, spermatoceles have grown to roughly the size of a normal testicle and men are bothered both by pain and mass symptoms.