Effective strategies for managing trimethoprim-sulfamethoxazole and levofloxacin-resistant Stenotrophomonas maltophilia infections: bridging the gap between scientific evidence and clinical practice.

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES
Current Opinion in Infectious Diseases Pub Date : 2024-12-01 Epub Date: 2024-07-29 DOI:10.1097/QCO.0000000000001039
David Mokrani, Charles-Edouard Luyt
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引用次数: 0

Abstract

Purpose of review: To discuss the therapeutic options available for the management of difficult-to-treat strains of Stenotrophomonas maltophilia ( Sma ), namely those resistant to trimethoprim-sulfamethoxazole and fluoroquinolones.

Recent findings: Recent pharmacological studies have highlighted the fact that current breakpoints for first-line antibiotics against Sma are too high. In light of these data, it is likely that the prevalence of difficult-to-treat (DTR) Sma is underestimated worldwide. Two promising alternatives for treating DTR strains are cefiderocol and the combination of aztreonam and an L2 inhibitor. However, clinical trials are currently very limited for these antibiotics and no comparative studies have been carried out to date. It is important to note that the clinical efficacy of cefiderocol appears to be inferior to that initially anticipated from in-vitro and animal studies. Consequently, minocycline and ceftazidime may remain viable options if they are used against strains with a low minimum inhibitory concentration. We advise against the use of intravenous polymyxins and tigecycline. Finally, recent literature does not support the systematic use of combination therapy or long-course treatments. In the coming years, phage therapy may become a promising approach against DTR Sma infections.

Summary: Overall, clinical comparative studies focused on DTR strains are required in order to provide more accurate and actionable information for therapeutic decisions.

管理耐甲氧苄啶-磺胺甲恶唑和耐左氧氟沙星嗜麦芽糖单胞菌感染的有效策略:弥合科学证据与临床实践之间的差距。
综述目的:讨论治疗嗜麦芽霉单胞菌(Sma)难治菌株(即对三甲双氨-磺胺甲噁唑和氟喹诺酮类药物耐药的菌株)的治疗方案:最近的药理学研究表明,目前针对 Sma 的一线抗生素的断点过高。鉴于这些数据,全球范围内难以治疗(DTR)的斯马菌的流行率很可能被低估了。治疗 DTR 菌株的两种有前途的替代药物是头孢克洛和阿曲南及 L2 抑制剂的组合。然而,目前针对这些抗生素的临床试验非常有限,而且迄今为止尚未开展过比较研究。值得注意的是,头孢羟氨苄的临床疗效似乎不如最初在体外和动物实验中预期的疗效。因此,如果使用米诺环素和头孢他啶来治疗最低抑菌浓度较低的菌株,它们仍然是可行的选择。我们建议不要静脉注射多粘菌素和替加环素。最后,近期的文献并不支持系统地使用联合疗法或长疗程治疗。小结:总体而言,需要开展以 DTR 菌株为重点的临床比较研究,以便为治疗决策提供更准确、更可行的信息。
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来源期刊
CiteScore
6.70
自引率
2.60%
发文量
121
审稿时长
6-12 weeks
期刊介绍: This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.
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