Shauna Jacobson Junco1, Mary Catherine Bowman2, R Brigg Turner3. 1. Department of Pharmacy, Orlando Health, Orlando, FL, USA. Electronic address: shauna.junco@orlandohealth.com. 2. Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 3. School of Pharmacy, Pacific University, Hillsboro, OR, USA. Electronic address: brigg.turner@pacificu.edu.
Abstract
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.
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.
Authors: Maxwell J Lasko; Matthew L Gethers; Jennifer L Tabor-Rennie; David P Nicolau; Joseph L Kuti Journal: Antimicrob Agents Chemother Date: 2022-01-10 Impact factor: 5.938
Authors: Maria F Mojica; Romney Humphries; John J Lipuma; Amy J Mathers; Gauri G Rao; Samuel A Shelburne; Derrick E Fouts; David Van Duin; Robert A Bonomo Journal: JAC Antimicrob Resist Date: 2022-05-05