Infection · 2026
Comparison of clinical and safety outcomes in patients with Stenotrophomonas maltophilia bacteremia: a trimethoprim/sulfamethoxazole versus levofloxacin monotherapy.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Chen Chien-Liang, Chen Wei-Ping, Chang Feng-Yee, Yu Ching-Mei, Siu L Kristopher, Yang Ya-Sung, Lin Jung-Chung, Wang Ching-Hsun
Аннотация
PURPOSE: The study aimed to compare the clinical outcomes and safety of trimethoprim/sulfamethoxazole (TMP/SMX) versus levofloxacin monotherapy in patients with monomicrobial Stenotrophomonas maltophilia (S. maltophilia) bacteremia.
METHODS: We conducted a retrospective cohort study of adult inpatients with monomicrobial S. maltophilia bacteremia at a tertiary medical center in Taiwan from January 2004 to June 2025. Patients were divided into two groups for comparison based on antibiotic treatment: TMP/SMX and levofloxacin monotherapy. Primary outcome was 30-day mortality. Secondary outcomes included in-hospital mortality, clinical response, microbiological eradication, non-susceptible strains emergence, recurrent bacteremia, and adverse drug reactions. Multivariable logistic regression and propensity score analysis were performed using inverse probability of treatment weighting (IPTW).
RESULTS: Among 226 patients, 129 received levofloxacin and 97 received TMP/SMX. The levofloxacin-treated group was associated with lower 30-day mortality (17.8% vs. 36.1%, p = 0.002) in the primary analysis. In the multivariable logistic regression model, levofloxacin use was independently associated with improved outcomes (p = 0.047). Similarly, in the IPTW analysis, levofloxacin use remained a factor of lower 30-day mortality (p = 0.026). Additionally, microbiological eradication, emergence of non-susceptible strains, and recurrent bacteremia were comparable between the treatment groups, while adverse events were significantly less frequent in patients treated with levofloxacin (3.1% vs. 25.8%, p < 0.001).
CONCLUSIONS: Levofloxacin appeared to be more effective and safer than TMP/SMX in this retrospective analysis; however, this interpretation should be made with caution given the observational nature of the study. Further randomized clinical trials are warranted to validate these findings.
METHODS: We conducted a retrospective cohort study of adult inpatients with monomicrobial S. maltophilia bacteremia at a tertiary medical center in Taiwan from January 2004 to June 2025. Patients were divided into two groups for comparison based on antibiotic treatment: TMP/SMX and levofloxacin monotherapy. Primary outcome was 30-day mortality. Secondary outcomes included in-hospital mortality, clinical response, microbiological eradication, non-susceptible strains emergence, recurrent bacteremia, and adverse drug reactions. Multivariable logistic regression and propensity score analysis were performed using inverse probability of treatment weighting (IPTW).
RESULTS: Among 226 patients, 129 received levofloxacin and 97 received TMP/SMX. The levofloxacin-treated group was associated with lower 30-day mortality (17.8% vs. 36.1%, p = 0.002) in the primary analysis. In the multivariable logistic regression model, levofloxacin use was independently associated with improved outcomes (p = 0.047). Similarly, in the IPTW analysis, levofloxacin use remained a factor of lower 30-day mortality (p = 0.026). Additionally, microbiological eradication, emergence of non-susceptible strains, and recurrent bacteremia were comparable between the treatment groups, while adverse events were significantly less frequent in patients treated with levofloxacin (3.1% vs. 25.8%, p < 0.001).
CONCLUSIONS: Levofloxacin appeared to be more effective and safer than TMP/SMX in this retrospective analysis; however, this interpretation should be made with caution given the observational nature of the study. Further randomized clinical trials are warranted to validate these findings.