Sulfamethoxazole/trimethoprim versus fluoroquinolones for the treatment of Stenotrophomonas maltophilia bloodstream infections

Objectives: Stenotrophomonas maltophilia causes high mortality rates, especially in bloodstream infections (BSIs) where there is a lack of comparative data with fluoroquinolones (FQs) and sulfamethoxazole/trimethoprim (SXT). The objective of this study was to evaluate outcomes in patients with S. maltophilia BSI who were treated with FQs versus SXT. Methods: A retrospective study was conducted to compare FQs (levofloxacin, ciprofloxacin and moxifloxacin) versus SXT for the treatment of S. maltophilia BSI. Results: A total of 54 patients were included in this retrospective study, including 32 treated with SXT and 22 treated with FQs (11 ciprofloxacin, 5 levofloxacin and 6 moxifloxacin). There were 3 deaths (13.6%) in the FQ group versus 10 (31.3%) in the SXT group (P = 0.20). Modified Acute Physiology and Chronic Health Evaluation (APACHE) II score [odds ratio (OR) = 1.4, 95% confidence interval (CI) 1.1-1.8] and broadspectrum antibiotics prior to culture (OR = 8, 95% CI 1.3-49.8) were significant predictors of mortality. Conclusions: Ciprofloxacin, moxifloxacin and levofloxacin are possible alternatives to SXT for S. maltophilia BSI; however, further investigation is needed to confirm these findings. (C) 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.