From the Research
The recommended treatment duration for disseminated Stenotrophomonas maltophilia infection is typically 14 days, though this may be extended to 21-28 days for severe infections, particularly those involving deep-seated sites or in immunocompromised patients. The first-line treatment is trimethoprim-sulfamethoxazole (TMP-SMX) at a dosage of 5 mg/kg of the trimethoprim component every 8-12 hours, as it is recognized as the first-line therapy for S. maltophilia infections due to its good in vitro activity and favorable clinical outcomes 1. For patients who cannot tolerate TMP-SMX, alternative options include fluoroquinolones (levofloxacin 750 mg daily or moxifloxacin 400 mg daily), minocycline (100 mg twice daily), or combination therapy with ceftazidime (2 g every 8 hours) plus ticarcillin-clavulanate (3.1 g every 4-6 hours) 2, 3, 4.
Some key points to consider when treating disseminated Stenotrophomonas maltophilia infections include:
- Treatment should be guided by antimicrobial susceptibility testing as S. maltophilia has intrinsic resistance to many antibiotics 1, 4.
- Source control through drainage of abscesses or removal of infected devices is crucial when applicable.
- Close monitoring for clinical improvement is essential, and treatment may need adjustment based on clinical response.
- The extended duration is necessary because S. maltophilia is an opportunistic pathogen with intrinsic resistance mechanisms that can make eradication difficult, particularly in disseminated infections where the organism has spread to multiple body sites.
- Recent studies suggest that levofloxacin may be a reasonable alternative to TMP-SMX for the treatment of bloodstream and lower respiratory tract infections caused by S. maltophilia, with similar mortality risk and fewer hospital days 5.
It's worth noting that the latest guidance issued by the Infectious Diseases Society of America (IDSA) recommends using these agents only as part of a combination therapy, and novel therapeutic options such as cefiderocol (FDC) and ceftazidime-avibactam plus aztreonam (CZA-ATM) are suggested, based on limited but promising clinical data 1. However, more research is needed to optimize current treatment options.