Department of Pharmacy, Orlando Health, Orlando, FL, USA.
Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Int J Antimicrob Agents. 2021 Aug;58(2):106367. doi: 10.1016/j.ijantimicag.2021.106367. Epub 2021 May 28.
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.
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.
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.
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.
嗜麦芽窄食单胞菌感染的历史治疗选择是复方磺胺甲噁唑，这主要基于临床前研究。本研究的目的是研究接受不同药物单药治疗的患者的临床结局。
这是一项回顾性研究，纳入了 2010 年至 2016 年期间接受复方磺胺甲噁唑（TMP/SMX）、氟喹诺酮或米诺环素单药治疗嗜麦芽窄食单胞菌感染的成年患者。主要结局是临床失败，包括复发、因不良反应或临床失败而改变治疗、或 30 天院内死亡率。次要结局是 30 天院内死亡率。为了考虑治疗选择偏倚，进行了多变量回归和倾向评分加权。
共纳入 284 例患者（217 例接受 TMP/SMX，28 例接受氟喹诺酮，39 例接受米诺环素）。TMP/SMX 和米诺环素组似乎纳入了相似的患者，而氟喹诺酮组似乎代表了病情稍轻的人群。各组之间的临床失败率相似（TMP/SMX、氟喹诺酮和米诺环素组分别为 36%、29%和 31%，P=0.69），30 天死亡率也相似（TMP/SMX、氟喹诺酮和米诺环素组分别为 15%、7%和 5%，P=0.16）。在校正混杂因素后，与 TMP/SMX 相比，接受米诺环素（校正优势比[OR]=0.2[0.1-0.7]）而不是氟喹诺酮（校正 OR=0.3[0.1 至 2.1]）与较低的死亡率相关。这种关联在倾向评分加权后仍然存在。
与 TMP/SMX 单药治疗相比，替代治疗的结局相似或更好，这表明复方磺胺甲噁唑可能不是治疗嗜麦芽窄食单胞菌感染的首选药物。
