Int J Antimicrob Agents. 2021 May 28:106367. doi: 10.1016/j.ijantimicag.2021.106367. Online ahead of print.
OBJECTIVES: The historical treatment of choice for Stenotrophomonas maltophilia infection is trimethoprim-sulfamethoxazole; this is primarily based on pre-clinical 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 was 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 while the fluoroquinolone group appeared to represent a slightly less severely-ill population. Clinical failure was similar between groups (36%, 29%, and 31% in TMP-SMX, fluoroquinolone, and minocycline groups respectively, P=0.69) as was 30-day mortality (15%, 7%, and 5% in TMP-SMX, fluoroquinolone, and minocycline groups respectively, P=0.16). After controlling for confounding factors, receipt of minocycline (adjusted 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 to TMP-SMX. This association persisted after propensity-score weighting.
CONCLUSIONS: As outcomes were similar or better with alternatives, this study suggests that TMP-SMX monotherapy may not be the treatment of choice for infections caused by S. maltophilia.