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Gibb J, Wong DW. Antimicrobial Treatment Strategies for Stenotrophomonas maltophilia: A Focus on Novel Therapies. Antibiotics (Basel) 2021; 10:antibiotics10101226. [PMID: 34680807 PMCID: PMC8532924 DOI: 10.3390/antibiotics10101226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 12/31/2022] Open
Abstract
Stenotrophomonas maltophilia is an urgent global threat due to its increasing incidence and intrinsic antibiotic resistance. Antibiotic development has focused on carbapenem-resistant Enterobacteriaceae, Pseudomonas, and Acinetobacter, with approved antibiotics in recent years having limited activity for Stenotrophomonas. Accordingly, novel treatment strategies for Stenotrophomonas are desperately needed. We conducted a systemic literature review and offer recommendations based on current evidence for a treatment strategy of Stenotrophomonas infection.
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Ahlström MG, Knudsen JD, Hertz FB. Stenotrophomonas maltophilia bacteraemia: 61 cases in a tertiary hospital in Denmark. Infect Dis (Lond) 2021; 54:26-35. [PMID: 34392797 DOI: 10.1080/23744235.2021.1963470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Stenotrophomonas maltophilia is an opportunistic pathogen and a dreaded cause of bacteraemia with 30-day mortality rates ranging from 14 to 69%. The purpose of this cohort study was to evaluate outcomes of S. maltophilia bacteraemia, at Rigshospitalet, a tertiary hospital in Copenhagen, Denmark. METHODS We included all patients with a blood culture positive for S. maltophilia, from January 1, 2015 to April 1, 2020. We extracted data on antimicrobial susceptibility, treatment, central venous catheter intervention and severe haematological disease. RESULTS Sixty-one cases of S. maltophilia bacteraemia were identified. The overall 90-day mortality was 18%. Sixty percent of patients had a central venous catheter intervention performed. Seventy-nine percent of patients were treated with trimethoprim/sulfamethoxazole (TMP/SMX). Patients with central venous catheter intervention had significantly better survival than those without (HR: 0.16 [95% CI: 0.03-0.73]). Severe haematological disease and patients, who received intensive care unit (ICU) care, were at higher risk of death than other patients (HR: 5.93 [95% CI: 1.18 - 29.94] and HR: 8.37 [95% CI: 1.79 - 39.20], respectively). We found no evidence that any antibiotic regime was superior with regard to 90-day mortality. CONCLUSIONS We did not find evidence to support a change in the current standard-of-care regimen of TMP/SMX and CVC removal. Larger clinical trials are needed to guide such recommendations.
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Affiliation(s)
- Magnus G Ahlström
- Department of Clinical Microbiology 9301, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology 9301, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Frederik Boëtius Hertz
- Department of Clinical Microbiology 9301, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Zha L, Zhang D, Pan L, Ren Z, Li X, Zou Y, Li S, Luo S, Yang G, Tefsen B. Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study. Infect Dis Ther 2021; 10:2415-2429. [PMID: 34374953 PMCID: PMC8354101 DOI: 10.1007/s40121-021-00516-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/27/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Tigecycline is a potential alternative to trimethoprim–sulfamethoxazole in treating Stenotrophomonas maltophilia infections due to its potent in vitro antimicrobial activity. Clinical evidence regarding the use of tigecycline in the treatment of S. maltophilia infections is scarce. In this study, we assessed the efficacy of tigecycline treating ventilator-associated pneumonia (VAP) due to S. maltophilia in comparison with fluoroquinolones. Methods This is a multicenter retrospective cohort study of patients admitted between January 2017 and December 2020 with the diagnosis of VAP caused by S. maltophilia receiving either tigecycline or fluoroquinolones as the definitive therapy ≥ 48 h. Clinical outcomes including 28-day mortality, clinical cure and microbiological cure were analyzed. Results Of 82 patients with S. maltophilia VAP included, 46 received tigecycline, and 36 received fluoroquinolones; 70.7% of patients had polymicrobial pneumonia, and the appropriate empiric therapy was applied to only 14.6% of patients. The overall 28-day mortality was 39%. Compared with patients receiving fluoroquinolones, tigecycline therapy resulted in worse clinical cure (32.6% vs. 63.9%, p = 0.009) and microbiological cure (28.6% vs. 59.1%, p = 0.045), while there was no statistical difference between 28-day mortality (47.8% vs. 27.8%, p = 0.105) in the two groups. Similar results were also shown in the inverse probability of treatment weighted univariable regression model and multivariable regression model. Conclusions The standard dose of tigecycline therapy was associated with a lower clinical and microbiological cure rate but not associated with an increased 28-day mortality in patients with S. maltophilia VAP compared with fluoroquinolones. Considering the unfavorable clinical outcomes, we therefore recommend against using the standard dose of tigecycline in treating S. maltophilia VAP unless new clinical evidence emerges. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00516-5.
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Affiliation(s)
- Lei Zha
- Emergency and Critical Care Unit, Conch Hospital of Anhui Medical University, Wuhu, 241000, Anhui, China.
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, No. 111, Ren'ai Road, Dushu Lake Higher Education Town, Suzhou Industrial Park, Suzhou, 215123, Jiangsu, China.
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK.
| | - Dayan Zhang
- Postgraduate School, Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Lingling Pan
- Cardiology Department, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Zhichu Ren
- Postgraduate School, Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Xiang Li
- Postgraduate School, Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Yi Zou
- Postgraduate School, Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Shirong Li
- Pulmonary and Critical Care Department, The Second People's Hospital of Wuhu, Wuhu, 241000, Anhui, China
| | - Shuangqi Luo
- Intensive Care Unit, The First People's Hospital of Wuhu, Wuhu, 241000, Anhui, China
| | - Gang Yang
- Pulmonary and Critical Care Department, The Second People's Hospital of Wuhu, Wuhu, 241000, Anhui, China
| | - Boris Tefsen
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, No. 111, Ren'ai Road, Dushu Lake Higher Education Town, Suzhou Industrial Park, Suzhou, 215123, Jiangsu, China.
- Ronin Institute, Montclair, NJ, 07043, USA.
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