Article ; Online: Clinical outcomes of Stenotrophomonas maltophilia infection treated with trimethoprim/sulfamethoxazole, minocycline, or fluoroquinolone monotherapy.
International journal of antimicrobial agents
2021 Volume 58, Issue 2, Page(s) 106367
Abstract: Objectives: The historical treatment of choice for Stenotrophomonas maltophilia infection is trimethoprim/sulfamethoxazole and this is primarily based on preclinical studies. The objective of this study was to examine the clinical outcomes of patients ... ...
| Abstract | Objectives: The historical treatment of choice for Stenotrophomonas maltophilia infection is trimethoprim/sulfamethoxazole and this is primarily based on preclinical studies. The objective of this study was to examine the clinical outcomes of patients receiving monotherapy with different agents. Methods: This was a retrospective study of adult patients receiving monotherapy for S. maltophilia infection with trimethoprim/sulfamethoxazole (TMP/SMX), a fluoroquinolone, or minocycline from 2010 to 2016. The primary outcome was clinical failure, a composite of recurrence, alteration of therapy due to adverse reaction or concern for clinical failure, or 30-day in-hospital mortality. The secondary outcome was 30-day in-hospital mortality. To account for treatment selection bias, multivariate regression and propensity score weighting were conducted. Results: 284 patients were included (217 received TMP/SMX, 28 received a fluoroquinolone, and 39 received minocycline). The TMP/SMX and minocycline groups appeared to include similar patients whereas the fluoroquinolone group appeared to represent a slightly less severely ill population. Clinical failure was similar between groups (36%, 29%, and 31% in the TMP/SMX, fluoroquinolone, and minocycline groups, respectively, P=0.69) as was 30-day mortality (15%, 7%, and 5% in the TMP/SMX, fluoroquinolone, and minocycline groups, respectively, P=0.16). After controlling for confounding factors, receipt of minocycline (adjusted odds ratio [OR]=0.2 [0.1-0.7]) but not a fluoroquinolone (adjusted OR=0.3 [0.1 to 2.1]) was associated with lower mortality compared with TMP/SMX. This association persisted after propensity score weighting. Conclusions: Outcomes were similar or better with alternatives to TMP/SMX monotherapy, which indicates this may not be the treatment of choice for infections caused by S. maltophilia. |
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| MeSH term(s) | Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Cohort Studies ; Drug Resistance, Multiple, Bacterial/drug effects ; Female ; Fluoroquinolones/therapeutic use ; Gram-Negative Bacterial Infections/drug therapy ; Humans ; Male ; Middle Aged ; Minocycline/therapeutic use ; Retrospective Studies ; Stenotrophomonas maltophilia/drug effects ; Treatment Outcome ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use |
| Chemical Substances | Anti-Bacterial Agents ; Fluoroquinolones ; Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2) ; Minocycline (FYY3R43WGO) |
| Language | English |
| Publishing date | 2021-05-28 |
| Publishing country | Netherlands |
| Document type | Comparative Study ; Journal Article |
| ZDB-ID | 1093977-5 |
| ISSN | 1872-7913 ; 0924-8579 |
| ISSN (online) | 1872-7913 |
| ISSN | 0924-8579 |
| DOI | 10.1016/j.ijantimicag.2021.106367 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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