Monotherapy with Fluoroquinolone or Trimethoprim-Sulfamethoxazole for the Treatment of Stenotrophomonas maltophilia Infections.
Antimicrob Agents Chemother. 2013 Oct 21;
Authors: Wang YL, Scipione MR, Dubrovskaya Y, Papadopoulos J
Abstract
BackgroundTreatment of choice for Stenotrophomonas maltophilia is trimethoprim-sulfamethoxazole (SXT). Fluoroquinolones (FQs) have in-vitro activity against S. maltophilia; however there is limited published information on their effectiveness. The purpose of this study is to compare the effectiveness of FQs and SXT for the treatment of S. maltophilia.MethodsA retrospective review of 98 patients with S. maltophilia infections who received SXT or FQ monotherapy was conducted. Patients ≥18 years old with a positive culture for S. maltophilia and clinical signs of infection who received treatment for ≥48 hours were included. Microbiological cure and clinical response were evaluated at the end of therapy (EOT). In-hospital mortality and isolation of non-susceptible isolates were also evaluated.ResultsThirty-five patients received SXT and 63 patients received FQ; 48 patients received levofloxacin, and 15 patients received ciprofloxacin. The most common infection was pulmonary. Overall microbiological cure rate at EOT was 63%. Thirteen of 20 patients (65%) who received SXT and 23 of 37 (62%) patients who received a FQ had microbiological cure at EOT (p=0.832). Overall clinical success was 55%; 52% for those who received FQ, and 61% for those who received SXT (p=0.451). In-hospital mortality was 24%, which was similar in both groups (25% for FQ vs. 22% for SXT, p=0.546). Development of resistance on repeat culture was 30% for FQ and 20% for SXT (p=0.426).ConclusionsFluoroquinolone or SXT monotherapy may be equally effective for the treatment of S. maltophilia infections. Resistance was documented in subsequent isolates of S. maltophilia in both groups.
PMID: 24145530 [PubMed - as supplied by publisher]