Treatment outcomes of combination versus monotherapy in Stenotrophomonas maltophilia bacteremia: a retrospective single-center analysis
Abstract
A combination therapy (CT) is recommended for S. maltophilia infections; however, supporting clinical data are limited. This study aimed to compare the effectiveness and safety of CT and monotherapy (MT) in the treatment of S. maltophilia bacteremia. A total of 292 adult inpatients with monomicrobial S. maltophilia bacteremia who received in vitro active CT or MT for >48 h were included for comparison. Multivariable logistic regression analysis was performed. The primary outcome was 30-day mortality, and the secondary outcomes included in-hospital mortality, microbiological eradication rate, clinical response, recurrent bacteremia, isolation of non-susceptible S. maltophilia isolates, and adverse drug reaction (ADR) occurrence. Thirty-seven patients received CT, and 255 received MT. Overall, the 30-day mortality was 24.0%, and patients treated with CT had lower 30-day mortality than those with MT (10.8% vs 25.9%; P = 0.045). The multivariable regression analysis revealed that CT was an independent protective factor. In addition, sensitivity analyses excluding patients with bacterial co-infections showed a consistent trend. Other outcomes were similar between the groups: in-hospital mortality (37.8% vs 36.9%, P = 0.909), clinical response (73.0% vs 71.8%, P = 0.879), microbiological eradication rate (94.6% vs 93.0%, P = 1.000), recurrent bacteremia (0% vs 9.4%, P = 0.087), non-susceptible S. maltophilia isolation (24.3% vs 14.9%, P = 0.145), and ADR occurrence (8.1% vs 13.7%,…
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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.
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