Anti-Infective Research Laboratory, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.
Henry Ford Wyandotte, Wyandotte, Michigan, USA.
Pharmacotherapy. 2023 Aug;43(8):833-846. doi: 10.1002/phar.2828. Epub 2023 Jun 8.
Stenotrophomonas maltophilia is an opportunistic pathogen and frequent cause of serious nosocomial infections. Patient populations at greatest risk for these infections include the immunocompromised and those with chronic respiratory illnesses and prior antibiotic exposure, notably to carbapenems. Its complex virulence and resistance profile drastically limit available antibiotics, and incomplete breakpoint and pharmacokinetic/pharmacodynamic (PK/PD) data to inform dose optimization further complicates therapeutic approaches. Clinical comparison data of first-line agents, including trimethoprim-sulfamethoxazole (TMP-SMX), quinolones, and minocycline, are limited to conflicting observational data with no clear benefit of a single agent or combination therapy. Newer antibiotic approaches, including cefiderocol and aztreonam- avibactam, are promising alternatives for extensively drug-resistant isolates; however, clinical outcomes data are needed. The potential clinical utility of bacteriophage for compassionate use in treating S. maltophilia infections remains to be determined since data is limited to in-vitro and sparse in-vivo work. This article provides a review of available literature for S. maltophilia infection management focused on related epidemiology, resistance mechanisms, identification, susceptibility testing, antimicrobial PK/PD, and emerging therapeutic strategies.
嗜麦芽窄食单胞菌是一种机会致病菌，也是严重医院获得性感染的常见病原体。易发生此类感染的患者人群包括免疫功能低下者，以及患有慢性呼吸道疾病和既往抗生素暴露史（尤其是碳青霉烯类抗生素）者。其复杂的毒力和耐药谱极大地限制了可用的抗生素，而不完整的折点和药代动力学/药效学（PK/PD）数据也进一步使剂量优化的治疗方法变得复杂。一线药物（包括复方磺胺甲噁唑、喹诺酮类和米诺环素）的临床比较数据仅限于相互矛盾的观察性数据，没有单一药物或联合治疗的明确获益。新型抗生素方法，包括头孢地尔夫和头孢他啶-阿维巴坦，是治疗广泛耐药分离株的有前途的替代方法；然而，仍需要临床结局数据。噬菌体用于治疗嗜麦芽窄食单胞菌感染的同情使用的潜在临床效用仍有待确定，因为数据仅限于体外和体内工作稀疏。本文综述了嗜麦芽窄食单胞菌感染管理的相关文献，重点介绍了相关的流行病学、耐药机制、鉴定、药敏试验、抗菌药物 PK/PD 以及新兴的治疗策略。
