Clinical ineffectiveness of latamoxef for Stenotrophomonas maltophilia infection

Figures & data

Table 1 A summary of 12 cases with latamoxef treatment for Stenotrophomonas maltophilia infection

Case	Age (years)	Sex	Admission	Underlying conditions	SOFA score	Suspected infectious focus	S. maltophilia detection sites	Combined with antibiotics	Microbiologic failure	Prognosis (days)
1	80	M	ICU	Postoperation (hepatectomy), HCC (HCV), neutropenia	8	Intra-abdominal infection	Blood, sputum, ascites	None	Yes	Died (16)
2	31	M	ICU	Acute myelomonocytic leukemia (BMT), IA	13	Blood stream infection	Blood	T/S	No	Died (30)
3	81	M	ICU	Postoperation (hepatectomy), HCC	15	Intra-abdominal infection	Sputum, ascites	GM	Yes	Died (31)
4	60	M	ICU	CNPA, post-BMT chronic GVHD, DM	9	Pneumonia, intra-abdominal infection	Sputum, pleural effusion	LVFX, TEIC	Yes	Died (34)
5	51	M	ICU	ATLL (BMT)	8	Bacterial translocation	Blood	T/S, MINO, MEPM, DAP	No	Died (43)
6	1	M	ICU	Postoperation (congenital cardiac diseases)	15	Blood stream infection	Blood, sputum, pleural effusion	VCM	Yes	Died (5)
7	74	M	ICU	Postoperation (PD), neutropenia, IA	10	Pneumonia, intra-abdominal infection	Sputum, ascites, abscess	VCM	No	Survived
8	74	F	ICU	Aortic dissection, neutropenia, IA	9	Pneumonia	Sputum	LVFX, LZD	No	Survived
9	68	M	ICU	Burn, traumatic cardiac damage, IA	9	Burn site infection	Burn site	LVFX	No	Survived
10	61	M	ICU	Postoperation (liver transplantation), LC (HBV)	12	Intra-abdominal infection	Sputum, ascites	PIPC/TAZ, VCM	No	Survived
11	46	M	General ward	Postoperation (iliac bone graft harvesting) crest	–	Surgical site infection (osteomyelitis)	Blood, abscess	LVFX, DAP, MEPM	No	Survived
12	7	M	ICU	Postoperation (congenital cardiac diseases), neutropenia	10	Pneumonia	Sputum	CLDM, LVFX	Yes	Survived

Notes: Microbiologic failure was defined as a positive result of bacterial culture for Stenotrophomonas maltophilia even after administration of LMOX. Patients with neutropenia were defined as those who had <500/mm³ of neutrophil in peripheral blood.

Abbreviations: ATLL, adult T-cell leukemia/lymphoma; BMT, bone marrow transplantation; CLDM, clindamycin; CNPA, chronic necrotizing pulmonary aspergillosis; DAP, daptomycin; DM, diabetes mellitus; F, female; GM, gentamycin; GVHD, graft versus host disease; HCC, hepatocellular carcinoma; HBV, hepatitis B virus; HCV, hepatitis C virus; IA, immunosuppressive agents; ICU, intensive care unit; LC, liver cirrhosis; LMOX, latamoxef; LVFX, levofloxacin; LZD, linezolid; M, male; MEPM, meropenem; MIC, minimum inhibitory concentration (µg/mL); MINO, minocycline; PIPC/TAZ, piperacillin/tazobactum; SOFA, sequential organ failure assessment; T/S, trimethoprim/sulfamethoxazole; TEIC, teicoplanin; VCM, vancomycin; IA, included corticosteroids or tacrolimus after transplantation.

Table 2 Results of antibiotics susceptibility testing (µg/mL)

Case	T/S	MINO	LVFX	CAZ	LMOX
1	np	2	8	4	np
2	0.125/2.375	1	8	>16	8–16
3	1/19	4	>8	>16	8–64
4	0.125/2.375	≤0.5	0.5	>16	4
5	1/19	≤0.5	2	>16	4–8
6	1/19	≤0.5	0.5	>16	32
7	np	1	8	16	np
8	np	≤0.5	1	8	2–4
9	np	≤0.5	2	>16	np
10	0.25/4.75	≤0.5	8	1	1–4
11	2/38	≤0.5	2	1	1–4
12	2/38	≤0.5	1	16	4

Notes: Minimum inhibitory concentrations (µg/mL) are shown. Antibiotic susceptibility testing was performed according to Clinical and Laboratory Standards Institute (M100-S23). Antimicrobials that were sensitive to pathogenic organisms in each case are displayed in bold. Breakpoint of LMOX to Stenotrophomonas maltophilia is not defined, but those for patients who survived (Cases 7–12) were <4 µg/mL.

Abbreviations: CAZ, ceftazidime; LMOX, latamoxef; LVFX, levofloxacin; MINO, minocycline; np, not performed; T/S, trimethoprim/sulfamethoxazole.