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Steno-sphere: Navigating the enigmatic world of emerging multidrug-resistant Stenotrophomonas maltophilia

Ashlan J Kunz Coyne1, Shelbye Herbin2, Kaylee Caniff1

  • 1Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.

Pharmacotherapy
|May 18, 2023
PubMed

Insights

Stenotrophomonas maltophilia infections are challenging due to limited treatment options and complex resistance. This review examines current and emerging strategies for managing these serious nosocomial infections.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Antimicrobial Resistance

Background:

  • Stenotrophomonas maltophilia is a significant opportunistic pathogen causing nosocomial infections, particularly in immunocompromised individuals.
  • High rates of antibiotic resistance, especially to carbapenems, complicate treatment, necessitating a review of therapeutic strategies.
  • Limited clinical data on first-line agents and emerging therapies hinder optimal patient management.

Purpose of the Study:

  • To review the epidemiology, resistance mechanisms, and diagnostic approaches for Stenotrophomonas maltophilia infections.
  • To evaluate current and emerging antimicrobial therapies, including PK/PD data and novel agents.
  • To provide a comprehensive overview for optimizing the management of S. maltophilia infections.

Main Methods:

  • Literature review of epidemiology, resistance, diagnostics, and therapeutics for S. maltophilia.
  • Analysis of clinical comparison data for first-line antibiotics (TMP-SMX, quinolones, minocycline).
  • Assessment of newer agents (cefiderocol, aztreonam-avibactam) and bacteriophage therapy.

Main Results:

  • Conflicting observational data exist for first-line agents, with no clear preferred monotherapy or combination.
  • Emerging antibiotics like cefiderocol and aztreonam-avibactam show promise for drug-resistant strains, but require more outcome data.
  • Bacteriophage therapy for S. maltophilia infections is largely unexplored, with limited in-vitro and in-vivo evidence.

Conclusions:

  • Effective management of S. maltophilia infections requires understanding its complex resistance and virulence.
  • Further clinical outcome data are crucial for guiding the use of novel antimicrobial agents.
  • Comprehensive strategies integrating diagnostics, PK/PD, and emerging therapies are needed to combat these challenging infections.
Keywords:
Stenotrophomonas maltophiliaaztreonam-avibactambacteriophagecefiderocoleravacyclineminocyclineomadacyclineoutcomespharmacodynamics/pharmacokineticsquinoloneresistancetrimethoprim-sulfamethoxazole

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