Department of Molecular Biology and Microbiology, School of Medicine, Case Western Reserve University.
Case Western Reserve University-Cleveland VA Medical Center for Antimicrobial Resistance and Epidemiology, Cleveland, Ohio, USA.
Curr Opin Infect Dis. 2023 Dec 1;36(6):572-584. doi: 10.1097/QCO.0000000000000975. Epub 2023 Oct 16.
Stenotrophomonas maltophilia is an emerged opportunistic pathogen. Intrinsic multidrug resistance makes treating infections caused by S. maltophilia a great clinical challenge. Herein, we provide an update on the most recent literature on treatment options for severe S. maltophilia infections.
Trimethoprim-sulfamethoxazole (SXT) is recognized as the first-line therapy for S. maltophilia infections. However, its clinical use is based on good in vitro activity and favorable clinical outcomes, rather than on solid minimum inhibitory concentration (MIC) correlations with pharmacokinetic/pharmacodynamics (PK/PD) and/or clinical outcomes. The same is true for other treatment options like levofloxacin (LVX) and minocycline (MIN). Recent PK/PD studies question the current clinical breakpoints for SXT, LVX, and MIN. Based on this, the latest guidance issued by the Infectious Diseases Society of America (IDSA) recommends using these agents only as part of a combination therapy. Alternatively, novel therapeutic options such as cefiderocol (FDC) and ceftazidime-avibactam plus aztreonam (CZA-ATM) are suggested, based on limited but promising clinical data.
PK/PD data and controlled clinical studies are needed to optimize current treatment options. Presently, combination therapy of SXT, LVX, MIN, or FDC, or monotherapy with CZA-ATM are recommended therapeutic options for severe-to-moderate S. maltophilia infections.
嗜麦芽窄食单胞菌是一种新兴的机会致病菌。固有多重耐药性使得治疗嗜麦芽窄食单胞菌引起的感染成为一个巨大的临床挑战。本文就严重嗜麦芽窄食单胞菌感染的最新治疗选择的文献进行综述。
复方磺胺甲噁唑（SXT）被认为是治疗嗜麦芽窄食单胞菌感染的一线药物。然而，其临床应用是基于良好的体外活性和有利的临床结果，而不是基于最低抑菌浓度（MIC）与药代动力学/药效学（PK/PD）和/或临床结果的可靠相关性。其他治疗选择，如左氧氟沙星（LVX）和米诺环素（MIN）也是如此。最近的 PK/PD 研究对 SXT、LVX 和 MIN 的现行临床折点提出了质疑。基于这一点，美国传染病学会（IDSA）发布的最新指南建议仅将这些药物作为联合治疗的一部分使用。或者，根据有限但有前途的临床数据，建议使用新型治疗选择，如头孢地尔（FDC）和头孢他啶-阿维巴坦加氨曲南（CZA-ATM）。
需要 PK/PD 数据和对照临床试验来优化当前的治疗选择。目前，SXT、LVX、MIN 或 FDC 的联合治疗，或 CZA-ATM 的单药治疗，被推荐用于严重至中度嗜麦芽窄食单胞菌感染。
