Association between antimicrobial regimens and 28-day mortality in patients with Stenotrophomonas maltophilia infection: a propensity score-weighted analysis
Abstract
Stenotrophomonas maltophilia (S. maltophilia) infections carry a high mortality risk, and optimal therapy remains uncertain. We compared commonly used regimens for 28-day outcomes. We conducted a retrospective cohort study of adult inpatients with S. maltophilia infection between 2020 and 2023. Definitive regimens included fluoroquinolone (FQ) monotherapy, cefoperazone-sulbactam (CSL) monotherapy, CSL plus FQ, and CSL plus trimethoprim-sulfamethoxazole (TMP-SMX). Confounding was addressed using propensity score-based inverse probability of treatment weighting (IPTW). The primary outcome was 28-day all-cause mortality assessed with weighted Cox models and Kaplan-Meier analyses. Overall, 28-day mortality was 31% (81/261). In the IPTW-weighted analysis, shock and chronic respiratory failure were associated with higher 28-day mortality, whereas combination therapy, compared with monotherapy, was associated with lower mortality. In regimen-specific analyses, FQ monotherapy showed the highest mortality estimate. CSL monotherapy and CSL plus FQ were associated with lower mortality than FQ monotherapy, while CSL plus FQ did not differ significantly from CSL monotherapy. CSL plus TMP-SMX was associated with lower mortality than both monotherapy regimens and had numerically lower mortality than CSL plus FQ (7% vs 19%), although this difference was not statistically significant. In this IPTW-adjusted cohort, combination therapy, compared with monotherapy, was associated with better…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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