Monotherapy versus combination for the treatment of Stenotrophomonas maltophilia: a multicenter cohort study

ABSTRACT

Background

The aim of this study was to compare the safety and effectiveness of monotherapy versus combination therapy for the treatment of infections caused by S. maltophilia.

Methods

This retrospective, multicenter, cohort study included patients treated with either monotherapy or combination therapy for infections caused by S. maltophilia. Primary outcomes included overall in-hospital mortality, 30-day mortality, and clinical cure. Safety outcomes were also evaluated. Multivariable logistic regression was used as a control for confounding variables.

Results

A total of 407 patients were included, 330 patients received monotherapy and 77 patients received combination therapy. A total of 21% presented with concomitant bacteremia. After adjusting the differences between the two groups, there were no statistically significant differences between patients who received monotherapy versus combination therapy in clinical cure (55% vs 65%; OR, 0.72; 95% CI, 0.40–1.31) and overall in-hospital mortality (52% vs 49%; OR, 0.84; 95% CI, 0.45–1.57). However, patients who received monotherapy had a lower rate of 30-day mortality (28% vs 32%; OR, 0.45; 95% CI, 0.22–0.90) and acute kidney injury (9% vs 18%; OR, 0.35; 95% CI, 0.16–0.78).

Conclusion

Clinical outcomes did not significantly differ in patients who received combination therapy versus monotherapy. More data are needed to validate these findings.

KEYWORDS:

• Stenotrophomonas maltophilia
• monotherapy
• combination therapy
• treatment
• cohort study

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors wish to thank King Saud University, Riyadh, Saudi Arabia, for supporting this research project (RSP2024R74).

Ethics

This research followed the relevant guidelines and regulations of the Helsinki Declaration. IRB Approval of Research Project was granted. The need for informed consent was waived by the Human Research Ethics Committee.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author.

Author contributions

TA: conceptualization, investigation, methodology, original draft writing & editing, literature review, data extraction, quality assessment, and supervision. HA, ZA, RA, SAR, FA, LF, NA, AAG: screening of previous studies and data collection. KS, SAA, SA, AA: conceptualization, investigation, methodology, original draft review & editing. KBK, YSA: quality assessment, review of original draft, statistical analysis, and validation. All authors have contributed to and approved the final version of the manuscript and have agreed on the journal to which the article will be submitted. All authors agree to take responsibility and be accountable for the contents of the article and to share responsibility to resolve any questions raised about the accuracy or integrity of the published work.

Additional information

Funding

This paper was not funded.