International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Comparative efficacy and safety of antibacterial regimens for severe Stenotrophomonas maltophilia infections: A systematic review and network meta-analysis.
СтатьяСистематический обзорNetwork Meta-AnalysisСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Gao Suyu, Lu Yun, Qiao Qi
Аннотация
OBJECTIVES: To evaluate the clinical efficacy and survival benefits of alternative antimicrobial regimens compared to conventional TMP-SMX in treating multidrug-resistant Stenotrophomonas maltophilia infections.
METHODS: We searched PubMed, Embase, Cochrane, and Web of Science up to April 2026 for cohorts comparing TMP-SMX, levofloxacin, minocycline, and tigecycline. A frequentist random-effects network meta-analysis was performed. Primary outcomes were overall survival and clinical efficacy (odds ratios [ORs] with 95% CIs). Treatments were ranked by SUCRA.
RESULTS: Fifteen cohorts were included. Levofloxacin significantly improved survival versus TMP-SMX (OR = 2.01, 95%CI 1.16-3.47, P = 0.012). Tigecycline showed the highest clinical response (OR = 4.97, 95%CI 1.69-14.61, P = 0.004) but no survival benefit. SUCRA ranked levofloxacin first for mortality reduction (91.3%) and tigecycline first for efficacy (91.3%); minocycline performed consistently across endpoints.
CONCLUSIONS: A "survival paradox" exists in SMA treatment: tigecycline yields superior initial response without improving survival, whereas levofloxacin provides the most significant survival benefit. Levofloxacin should be prioritized for critically ill patients, while high-dose TMP-SMX and tigecycline warrant cautious re-evaluation.
METHODS: We searched PubMed, Embase, Cochrane, and Web of Science up to April 2026 for cohorts comparing TMP-SMX, levofloxacin, minocycline, and tigecycline. A frequentist random-effects network meta-analysis was performed. Primary outcomes were overall survival and clinical efficacy (odds ratios [ORs] with 95% CIs). Treatments were ranked by SUCRA.
RESULTS: Fifteen cohorts were included. Levofloxacin significantly improved survival versus TMP-SMX (OR = 2.01, 95%CI 1.16-3.47, P = 0.012). Tigecycline showed the highest clinical response (OR = 4.97, 95%CI 1.69-14.61, P = 0.004) but no survival benefit. SUCRA ranked levofloxacin first for mortality reduction (91.3%) and tigecycline first for efficacy (91.3%); minocycline performed consistently across endpoints.
CONCLUSIONS: A "survival paradox" exists in SMA treatment: tigecycline yields superior initial response without improving survival, whereas levofloxacin provides the most significant survival benefit. Levofloxacin should be prioritized for critically ill patients, while high-dose TMP-SMX and tigecycline warrant cautious re-evaluation.