Treatment approaches for severe Stenotrophomonas maltophilia infections.

IF 3.6 3区医学 Q2 INFECTIOUS DISEASES

Current Opinion in Infectious Diseases Pub Date : 2023-12-01 Epub Date: 2023-10-16 DOI:10.1097/QCO.0000000000000975

Maria F Mojica, Robert A Bonomo, David van Duin

{"title":"Treatment approaches for severe Stenotrophomonas maltophilia infections.","authors":"Maria F Mojica, Robert A Bonomo, David van Duin","doi":"10.1097/QCO.0000000000000975","DOIUrl":null,"url":null,"abstract":"Purpose of review: 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.Recent findings: 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.Summary: 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.","PeriodicalId":10880,"journal":{"name":"Current Opinion in Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":3.6000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Opinion in Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/QCO.0000000000000975","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/10/16 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose of review: 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.

Recent findings: 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.

Summary: 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.

查看原文本刊更多论文

严重嗜麦芽窄食单胞菌感染的治疗方法。

综述目的：嗜麦芽窄食单胞菌是一种新出现的机会性病原体。固有的多药耐药性使得治疗嗜麦芽糖链球菌引起的感染成为一个巨大的临床挑战。在此，我们提供了关于严重嗜麦芽糖链球菌感染的治疗选择的最新文献的更新。最近的研究结果：三甲氧嘧啶-磺胺甲恶唑（SXT）被认为是治疗嗜麦芽糖链球菌感染的一线药物。然而，其临床应用是基于良好的体外活性和良好的临床结果，而不是基于固体最小抑制浓度（MIC）与药代动力学/药效学（PK/PD）和/或临床结果的相关性。其他治疗方案也是如此，如左氧氟沙星（LVX）和米诺环素（MIN）。最近的PK/PD研究对SXT、LVX和MIN的当前临床断点提出了质疑。基于此，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，基于有限但有前景的临床数据，提出了新的治疗方案，如头孢iderocol（FDC）和头孢他啶-阿维巴坦加氨曲南（CZA-ATM）。总结：需要PK/PD数据和对照临床研究来优化当前的治疗方案。目前，SXT、LVX、MIN或FDC的联合治疗，或CZA-ATM的单一治疗是严重至中度嗜麦芽糖链球菌感染的推荐治疗方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Current Opinion in Infectious Diseases 医学-传染病学

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.