Combination therapy with cefiderocol and minocycline for Stenotrophomonas maltophilia bacteremia in an obese patient on maintenance hemodialysis: A case report.

Stenotrophomonas maltophilia bacteremia is associated with high mortality and multidrug resistance and has limited treatment options. Clinical evidence for cefiderocol (CFDC) and combination regimens remains scarce. Herein, we report a case of S. maltophilia bacteremia, which emerged following initial polymicrobial bloodstream, intra-abdominal, and pleural infections, successfully treated with a combination of CFDC and minocycline (MINO) in a man in his 40s. Faced with constraints such as obesity (body mass index, 35 kg/m2), maintenance hemodialysis, and a temporary CFDC shortage, the dosage was optimized stepwise based on pharmacokinetic principles and the dialysis modality, alongside appropriate source control. Bacterial clearance was achieved without recurrence. This case adds valuable clinical insight to the literature by suggesting that combination therapy with CFDC and MINO may serve as a feasible, safe, and effective therapeutic option for S. maltophilia bacteremia in obese patients undergoing maintenance hemodialysis. Additionally, it provides a practical example of a rational, pharmacokinetic/pharmacodynamic-based decision-making process under multiple concurrent constraints, including drug shortages and uncertain antimicrobial susceptibility. However, given the inherent limitations of a single case report, prospective pharmacokinetic studies and comparative clinical data are needed before generalized recommendations can be made.