Tigecycline in the Treatment of Ventilator-Associated Pneumonia Due to Stenotrophomonas maltophilia: A Multicenter Retrospective Cohort Study

Abstract

Introduction Tigecycline is a potential alternative to trimethoprim–sulfamethoxazole in treating Stenotrophomonas maltophilia infections due to its potent in vitro antimicrobial activity. Clinical evidence regarding the use of tigecycline in the treatment of S. maltophilia infections is scarce. In this study, we assessed the efficacy of tigecycline treating ventilator-associated pneumonia (VAP) due to S. maltophilia in comparison with fluoroquinolones. Methods This is a multicenter retrospective cohort study of patients admitted between January 2017 and December 2020 with the diagnosis of VAP caused by S. maltophilia receiving either tigecycline or fluoroquinolones as the definitive therapy ≥ 48 h. Clinical outcomes including 28-day mortality, clinical cure and microbiological cure were analyzed. Results Of 82 patients with S. maltophilia VAP included, 46 received tigecycline, and 36 received fluoroquinolones; 70.7% of patients had polymicrobial pneumonia, and the appropriate empiric therapy was applied to only 14.6% of patients. The overall 28-day mortality was 39%. Compared with patients receiving fluoroquinolones, tigecycline therapy resulted in worse clinical cure (32.6% vs. 63.9%, p = 0.009) and microbiological cure (28.6% vs. 59.1%, p = 0.045), while there was no statistical difference between 28-day mortality (47.8% vs. 27.8%, p = 0.105) in the two groups. Similar results were also shown in the inverse probability of treatment weighted univariable regression model and multivariable regression model. Conclusions The standard dose of tigecycline therapy was associated with a lower clinical and microbiological cure rate but not associated with an increased 28-day mortality in patients with S. maltophilia VAP compared with fluoroquinolones. Considering the unfavorable clinical outcomes, we therefore recommend against using the standard dose of tigecycline in treating S. maltophilia VAP unless new clinical evidence emerges. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00516-5.

Antimicrobial Treatment Strategies for Stenotrophomonas maltophilia: A Focus on Novel Therapies

“…In contrast, a retrospective cohort of 82 patients in three tertiary Chinese hospitals with ventilatorassociated pneumonia was reviewed: 46 who received tigecycline and 36 fluroquinolone therapy. In comparison with fluoroquinolone treatment, patients treated with tigecycline were found to have a significantly worse clinical cure (32.6% compared to 63.9%) and a lower rate of microbiological cure (28.6% as opposed to 59.1%) with a trend towards increased 28-day mortality (48% vs. 28%), although this did not reach statistical significance [61]. The authors postulated subtherapeutic tigecycline drug levels at standard dosing as one potential contributor to these findings.…”

Multi-drug resistant gram-negative bacterial pneumonia: etiology, risk factors, and drug resistance patterns

“…Hemorrhagic pneumonia caused by S. maltophilia is a significant risk factor for mortality in patients with hematologic malignancy such as thrombocytopenia and prolonged neutropenia [ 136 ]. Currently, tigecycline is a promising alternative to trimethoprim-sulfamethoxazole and fluoroquinolones for treating VAP caused by S. maltophilia, but its resistance to available antibiotics has increased [ 137 ].…”

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

“…A multicenter retrospective study evaluated 82 patients with S. maltophilia VAP receiving standard dosing of tigecycline (n = 46) or a quinolone (n = 36). 100 In both unadjusted and inverse probability of A single-center retrospective cohort study of evaluated patients with S. maltophilia infections from any source and receipt of ≥5 days of minocycline, TMP-SMX, or moxifloxacin monotherapy. 101 The primary outcome was a composite of complete success, defined as meeting the following criteria: "(i) resolution of signs and symptoms, (ii) no repeat isolation 30 days after EOT, and (iii) no switch or addition of alternative S. maltophilia agents."…”