Efficacy of combination therapy with minocycline for treating Stenotrophomonas maltophilia infections
Abstract
Abstract Background Stenotrophomonas maltophilia is a multidrug-resistant opportunistic pathogen associated with substantial in-hospital mortality. However, data supporting the efficacy of treating S. maltophilia infections using a combination of antimicrobials remain inconclusive. Objectives To assess whether adjunctive minocycline improves clinical outcomes of S. maltophilia infections compared with standard monotherapy. Methods This randomized, double-blind, placebo-controlled trial was conducted at Siriraj Hospital, Thailand. Adults with confirmed S. maltophilia infections were randomized to receive minocycline or a matching placebo in addition to monotherapy with either levofloxacin or trimethoprim/sulfamethoxazole. Results This trial enrolled 112 patients (71.4% [n = 80/112] of patients requiring an intensive care unit [ICU] and 66.1% [n = 74/112] of patients were diagnosed with ventilator-associated pneumonia [VAP]). Baseline demographic and clinical characteristics were balanced between intervention and control groups. Adjunctive minocycline did not significantly reduce 28-day-mortality (n = 24/55[43.6%] vs n = 22/57[38.6%], P = 0.590) but did achieve significantly higher microbiological response rates at early assessment (n = 25/55[45.5%] vs n = 8/57[14.0%], P < 0.001) and the end of treatment (n = 44/55[80.0%] vs n = 32/57[56.1%], P = 0.023). In contrast, clinical response rates did not differ between groups at either 72 h after the start of study treatment or the…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 112 participants or records.
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