Propensity-Matched Comparison of Timely vs Delayed Antibiotic Therapy in Stenotrophomonas maltophilia Pneumonia
Ashlan J Kunz Coyne1, Kristen Lucas1, Rachel Gray1
1Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky, USA.
Background:
Stenotrophomonas maltophilia, a multidrug-resistant nosocomial pathogen, is associated with high mortality and therapeutic challenges due to resistance. Empiric Gram-negative antibiotic regimens often lack activity against S. maltophilia, delaying effective therapy. This study evaluated timely versus delayed antibiotic therapy's impact on clinical outcomes in S. maltophilia pneumonia patients.
Methods:
This retrospective cohort study included adults hospitalized with S. maltophilia pneumonia at the University of Kentucky HealthCare (2014-2023). Patients received active monotherapy or combination therapy with trimethoprim/sulfamethoxazole, minocycline, or levofloxacin. Timely therapy was defined as initiation ≤48 hours from index culture collection; delayed therapy as >48 hours. Propensity score matching minimized baseline differences. The Desirability of Outcome Ranking (DOOR) framework evaluated outcomes, prioritizing clinical efficacy and safety. Kaplan-Meier analysis assessed 30-day mortality. A Cox proportional hazards model with time-dependent covariates assessed therapy timing, adjusting for calendar year and COVID-19 time period.
Results:
Of 430 patients (215 per group), DOOR analysis showed a 72.8% probability (95% CI, 67.9%-77.1%; P < .001) that timely therapy resulted in patients being alive with fewer or no clinical events. Kaplan-Meier analysis confirmed higher survival with timely therapy (log-rank P < .001), with a 22.8% absolute reduction in 30-day mortality (survival rates: 87.9% timely vs 65.1% delayed). A time-dependent Cox model, adjusted for calendar year and COVID-19 time period, confirmed timely therapy reduced death hazard (adjusted hazard ratio: 0.48; 95% CI: .27-.86; P = .013).
Conclusions:
Timely therapy significantly improved survival and clinical outcomes in S. maltophilia pneumonia, highlighting the need for rapid, targeted treatment in managing resistant Gram-negative infections.
Insights
Timely antibiotic therapy for Stenotrophomonas maltophilia pneumonia significantly improves patient survival and clinical outcomes. Rapid treatment initiation is crucial for managing this multidrug-resistant pathogen.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pharmacology
Background:
- Stenotrophomonas maltophilia is a multidrug-resistant nosocomial pathogen linked to high mortality.
- Effective treatment is challenging due to antimicrobial resistance.
- Empiric antibiotic regimens often lack activity against S. maltophilia, delaying crucial therapy.
Purpose of the Study:
- To evaluate the impact of timely versus delayed antibiotic therapy on clinical outcomes in patients with S. maltophilia pneumonia.
- To assess the association between treatment initiation timing and patient survival.
- To analyze the efficacy of different therapeutic strategies for S. maltophilia infections.
Main Methods:
- Retrospective cohort study of adult patients with S. maltophilia pneumonia (2014-2023).
- Timely therapy defined as initiation ≤48 hours from culture; delayed therapy as >48 hours.
- Propensity score matching, Desirability of Outcome Ranking (DOOR) framework, Kaplan-Meier analysis, and Cox proportional hazards modeling were used.
Main Results:
- Timely therapy showed a 72.8% probability of improved clinical outcomes (alive with fewer/no events).
- Kaplan-Meier analysis revealed higher survival with timely therapy (log-rank P < .001), with a 22.8% absolute reduction in 30-day mortality.
- A time-dependent Cox model confirmed timely therapy significantly reduced the hazard of death (aHR: 0.48; P = .013).
Conclusions:
- Initiating antibiotic therapy within 48 hours significantly improves survival and clinical outcomes in S. maltophilia pneumonia.
- Rapid, targeted treatment is essential for managing infections caused by this resistant Gram-negative bacterium.
- The findings underscore the importance of prompt diagnosis and administration of effective antimicrobial agents.
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