Clinical and Microbiologic Outcomes in Trauma Patients Treated for <i>Stenotrophomonas maltophilia</i> Ventilator‐Associated Pneumonia

Czosnowski, Quinn; Wood, George C.; Magnotti, Louis J.; Croce, Martin A.; Swanson, Joseph M.; Boucher, Bradley A.; Fabian, Timothy C.

doi:10.1592/phco.31.4.338

Cited by 17 publications

(20 citation statements)

References 37 publications

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“…In the study by Samonis et al, the authors attributed the low mortality to the inclusion of non-critically ill patients, and the inclusion of patients with all infection types. Other studies identified mortality rates of 21 to 33%, which are consistent with the in-hospital mortality rate seen in this cohort (7)(8)(9)(10)(11)(12)(13). Similar to other studies, the cohort was not limited to bloodstream infections and included infections at other sites.…”

Section: Discussionsupporting

confidence: 88%

“…Clinical data on the use of FQs for S. maltophilia are scarce, and most studies that evaluated clinical success included only patients treated with SXT or ␤-lactams (6)(7)(8)10). Other studies reporting outcomes for alternative options for S. maltophilia infections did not evaluate outcomes based on individual drug classes, and studies that did evaluate treatment …”

Section: Discussionmentioning

confidence: 99%

“…with FQs are limited to case reports or the FQ was used in combination with other agents (6)(7)(8)(9)(10)(11)(12)(13). In a systematic review, 20 of the 49 cases described treatment with ciprofloxacin for S. maltophilia.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the increase in the patient population at risk, the incidence of S. maltophilia infections may be increasing (1,4). Mortality rates associated with S. maltophilia bacteremia range from 14 to 62%, with an attributable mortality of 20 to 30% (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Treatment of S. maltophilia infections can be difficult, as S. maltophilia is inherently resistant to many classes of antibiotics, including ␤-lactams and aminoglycosides.…”

mentioning

confidence: 99%

“…Treatment of S. maltophilia infections can be difficult, as S. maltophilia is inherently resistant to many classes of antibiotics, including ␤-lactams and aminoglycosides. Antibiotics with in vitro activity against S. maltophilia include trimethoprim-sulfamethoxazole (SXT), fluoroquinolones (FQs), tetracyclines, ticarcillin-clavulanate, and ceftazidime; however, there are limited clinical data on the use of these agents (6)(7)(8)(9)(10)14). Trimethoprim-sulfamethoxazole continues to be a primary choice for the treatment of S. maltophilia, but FQs are an attractive option due to in vitro activity (15).…”

mentioning

confidence: 99%

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Monotherapy with Fluoroquinolone or Trimethoprim-Sulfamethoxazole for Treatment of Stenotrophomonas maltophilia Infections

Wang

Scipione

Dubrovskaya

et al. 2014

Antimicrob Agents Chemother

109

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The treatment of choice for Stenotrophomonas maltophilia is trimethoprim-sulfamethoxazole (SXT). Fluoroquinolones (FQs) have in vitro activity against S. maltophilia; however, there is limited published information on their effectiveness. The purpose of this study is to compare the effectiveness of FQs and SXT for the treatment of S. maltophilia. A retrospective review of 98 patients with S. maltophilia infections who received SXT or FQ monotherapy was conducted. Patients >18 years old with a positive culture for S. maltophilia and clinical signs of infection who received treatment for >48 h were included. Microbiological cure and clinical response were evaluated at the end of therapy (EOT). In-hospital mortality and isolation of nonsusceptible isolates were also evaluated. Thirty-five patients received SXT, and 63 patients received FQ; 48 patients received levofloxacin, and 15 patients received ciprofloxacin. The most common infection was pulmonary. The overall microbiological cure rate at EOT was 63%. Thirteen of 20 patients (65%) who received SXT and 23 of 37 patients (62%) who received FQ had microbiological cure at EOT (P ‫؍‬ 0.832). The overall clinical success rate was 55%, 52% for those who received FQ and 61% for those who received SXT (P ‫؍‬ 0.451). In-hospital mortality was 24%, with similar rates in the two groups (25% for FQ versus 22% for SXT; P ‫؍‬ 0.546). Development of resistance on repeat culture was 30% for FQ and 20% for SXT (P ‫؍‬ 0.426). Fluoroquinolone and SXT monotherapies may be equally effective for the treatment of S. maltophilia infections. Resistance was documented in subsequent isolates of S. maltophilia in both groups.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Monotherapy with Fluoroquinolone or Trimethoprim-Sulfamethoxazole for Treatment of Stenotrophomonas maltophilia Infections

Wang

Scipione

Dubrovskaya

et al. 2014

Antimicrob Agents Chemother

109

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Steno‐sphere: Navigating the enigmatic world of emerging multidrug‐resistantStenotrophomonas maltophilia

et al. 2023

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Stenotrophomonas maltophilia is an opportunistic pathogen and frequent cause of serious nosocomial infections. Patient populations at greatest risk for these infections include the immunocompromised and those with chronic respiratory illnesses and prior antibiotic exposure, notably to carbapenems. Its complex virulence and resistance profile drastically limit available antibiotics, and incomplete breakpoint and pharmacokinetic/pharmacodynamic (PK/PD) data to inform dose optimization further complicates therapeutic approaches. Clinical comparison data of first‐line agents, including trimethoprim‐sulfamethoxazole (TMP‐SMX), quinolones, and minocycline, are limited to conflicting observational data with no clear benefit of a single agent or combination therapy. Newer antibiotic approaches, including cefiderocol and aztreonam‐ avibactam, are promising alternatives for extensively drug‐resistant isolates; however, clinical outcomes data are needed. The potential clinical utility of bacteriophage for compassionate use in treating S. maltophilia infections remains to be determined since data is limited to in‐vitro and sparse in‐vivo work. This article provides a review of available literature for S. maltophilia infection management focused on related epidemiology, resistance mechanisms, identification, susceptibility testing, antimicrobial PK/PD, and emerging therapeutic strategies.

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Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review

2020

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Background Little is known about the epidemiology of medication errors and medication-related harm following transition from secondary to primary care. This systematic review aims to identify and critically evaluate the available evidence on the prevalence and nature of medication errors and medication-related harm following hospital discharge. Methods Studies published between January 1990 and March 2019 were searched across ten electronic databases and the grey literature. No restrictions were applied with publication language or patient population studied. Studies were included if they contained data concerning the rate of medication errors, unintentional medication discrepancies, or adverse drug events. Two authors independently extracted study data. Results Fifty-four studies were included, most of which were rated as moderate (39/54) or high (7/54) quality. For adult patients, the median rate of medication errors and unintentional medication discrepancies following discharge was 53% [interquartile range 33-60.5] (n = 5 studies) and 50% [interquartile range 39-76] (n = 11), respectively. Five studies reported adverse drug reaction rates with a median of 27% [interquartile range 18-40.5] and seven studies reported adverse drug event rates with a median of 19% [interquartile range 16-24]. For paediatric patients, one study reported a medication error rate of 66.3% and another an adverse drug event rate of 9%. Almost a quarter of studies (13/54, 24%) utilised a follow-up period post-discharge of 1 month (range 2-180 days). Drug classes most commonly implicated with adverse drug events were antibiotics, antidiabetics, analgesics and cardiovascular drugs. Conclusions This is the first systematic review to explore the prevalence and nature of medication errors and adverse drug events following hospital discharge. Targets for future work have been identified.

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Clinical and Microbiologic Outcomes in Trauma Patients Treated for Stenotrophomonas maltophilia Ventilator‐Associated Pneumonia

Cited by 17 publications

References 37 publications

Monotherapy with Fluoroquinolone or Trimethoprim-Sulfamethoxazole for Treatment of Stenotrophomonas maltophilia Infections

Monotherapy with Fluoroquinolone or Trimethoprim-Sulfamethoxazole for Treatment of Stenotrophomonas maltophilia Infections

Steno‐sphere: Navigating the enigmatic world of emerging multidrug‐resistantStenotrophomonas maltophilia

Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review

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