What Drives Mortality in S. maltophilia Bloodstream Infections? An Outcome-Focused Cohort Study of Treatment Strategies and Resistance Profiles
Abstract
Stenotrophomonas maltophilia bloodstream infection (SM-BSI) carries high mortality and limited therapeutic options. We conducted a single-center retrospective cohort of adults with first SM-BSI (2018-2024) to describe treatment patterns and identify factors associated with survival. Demographic, clinical, and microbiological data were extracted and analyzed. Forty-three patients were included (median age: 63 years; 61% male). Appropriate antimicrobial therapy was given to 74%; trimethoprim-sulfamethoxazole-based regimens were used in 61%; and combination therapy in 23%. The median time from BSI to treatment initiation was 4 days (IQR: 3-5) and the treatment duration averaged 7 days (IQR: 0-12). Thirty-day mortality was 37% (16/43). The survival analysis found that a 14-21-day course was associated with better 30-day survival than a 7-13-day course (0/9 vs. 5/15 deaths; log-rank p = 0.045), whereas monotherapy and combination therapy did not differ (p = 0.855). Multidrug resistance was linked to worse survival (log-rank p = 0.001). In multivariable models for 30-day mortality, only active treatment (aHR: 0.14; 95% CI: 0.02-0.88) and microbiological cure (aHR: 0.08; 95% CI: 0.01-0.47) remained independently protective. These data suggest that outcomes in SM-BSI are driven primarily by the receipt of appropriate therapy and achievement of microbiological clearance, reinforcing the need for prompt source control, optimized antimicrobial treatment, and continued development of…
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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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