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Treatment approaches for severe Stenotrophomonas maltophilia infections

Maria F Mojica1,2,3, Robert A Bonomo2,4,5, David van Duin6

  • 1Department of Molecular Biology and Microbiology, School of Medicine, Case Western Reserve University.

Current Opinion in Infectious Diseases
|October 17, 2023
PubMed
Abstract

Insights

Treating Stenotrophomonas maltophilia infections is challenging due to multidrug resistance. Current first-line therapies like trimethoprim-sulfamethoxazole (SXT) lack strong PK/PD correlation, leading to recommendations for combination therapy or novel agents.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Pharmacology

Background:

  • Stenotrophomonas maltophilia is an opportunistic pathogen with intrinsic multidrug resistance, posing significant clinical treatment challenges.
  • Effective treatment strategies for S. maltophilia infections are crucial due to increasing resistance patterns.

Approach:

  • This review synthesizes recent literature on treatment options for severe S. maltophilia infections.
  • Analysis of pharmacokinetic/pharmacodynamic (PK/PD) data and clinical outcomes for various antimicrobial agents.

Key Points:

  • Trimethoprim-sulfamethoxazole (SXT), levofloxacin (LVX), and minocycline (MIN) are commonly used but lack robust PK/PD correlation with clinical outcomes.
  • Recent PK/PD studies challenge existing clinical breakpoints for SXT, LVX, and MIN.
  • Novel agents like cefiderocol (FDC) and ceftazidime-avibactam plus aztreonam (CZA-ATM) show promise but require further clinical validation.

Conclusions:

  • Optimizing S. maltophilia treatment requires more PK/PD data and controlled clinical studies.
  • Current recommendations for severe infections include combination therapy with SXT, LVX, MIN, or FDC, or monotherapy with CZA-ATM.

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