JAC Advance Access published online on July 28, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn301
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Systematic review |
Therapeutic options for Stenotrophomonas maltophilia infections beyond co-trimoxazole: a systematic review
1 Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece 2 Department of Medicine, Tufts University School of Medicine, Boston, MA, USA 3 Department of Medicine, Henry Dunant Hospital, Athens, Greece 4 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 5 Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
Received 16 April 2008; returned 22 May 2008; revised 23 June 2008; accepted 28 June 2008
* Correspondence address. Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Greece. Tel: +30-210-683-9604; Fax: +30-210-683-9605; E-mail: m.falagas{at}aibs.gr
Background: Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen, causing infections whose management is often problematic due to its inherent resistance to many antibiotics, making co-trimoxazole the main therapeutic option. However, there are cases in which either due to antimicrobial resistance or allergic reactions and intolerance to co-trimoxazole this antibiotic cannot be administered. We sought to evaluate the available clinical evidence regarding potentially effective alternative antibiotics for the treatment of S. maltophilia infections.
Methods: The literature search was performed in the PubMed and Scopus databases. The search string used was ‘Stenotrophomonas maltophilia OR Xanthomonas maltophilia'.
Results: Thirty-one case reports and 5 case series were retrieved including a total of 49 patients with a variety of infections. Twenty of 49 cases (40.8%) were treated with ciprofloxacin as monotherapy or in combination with other antibiotics; 12 of 49 cases (24.5%) were treated with ceftriaxone- or ceftazidime-based regimens; and 6 of 49 cases (12.2%) were treated with ticarcillin- or ticarcillin/clavulanate-based regimens. The cure or improvement rates were 18 cases (90%), 8 (75%) and 4 (66.7%), respectively. The remaining 11 patients received various antimicrobials including aminoglycoside-based regimens, carbapenems, levofloxacin, chloramphenicol, aztreonam, minocycline and other β-lactams.
Conclusions: The limited available data suggest that ciprofloxacin, ceftazidime or ceftriaxone, and ticarcillin/clavulanate, alone or in combination with other antibiotics, may be considered as alternative options beyond co-trimoxazole.
Key Words: ciprofloxacin , ceftazidime , ceftriaxone , antimicrobial resistance , ticarcillin/clavulanate , Xanthomonas , Pseudomonas