Trimethoprim-Sulfamethoxazole Versus Levofloxacin for Stenotrophomonas maltophilia Infections: A Retrospective Comparative Effectiveness Study of Electronic Health Records from 154 US Hospitals

• Type of Material: Article
• Authors: Sadia H Sarzynski, National Institutes of Health Clinical Center; Sarah Warner, National Institutes of Health Clinical Center; Junfeng Sun, National Institutes of Health Clinical Center; Roland Matsouaka, Duke University; John P Dekker, National Institute of Allergy and Infectious Diseases, Bethesda; Ahmed Babiker, Emory University; Willy Li, National Institutes of Health Clinical Center; Yi Ling Lai, National Institutes of Health Clinical Center; Robert L Danner, National Institutes of Health Clinical Center; Vance G Fowler, Duke University; Sameer S Kadri, National Institutes of Health Clinical Center
• Language: English
• Date: 2022-02-01
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofab644
• Title of Journal or Parent Work: OPEN FORUM INFECTIOUS DISEASES
• Volume: 9
• Issue: 2
• Start Page: ofab644
• End Page: ofab644
• Grant/Funding Information: This work was funded in part by the Intramural Research Program of the National Institutes of Health Clinical Center and the National Institute of Allergy and Infectious Diseases.
• Keywords: THERAPY; SUSCEPTIBILITY; Immunology; Microbiology; trimethoprim-sulfamethoxazole; MONOTHERAPY; Science & Technology; ANTIMICROBIAL SURVEILLANCE PROGRAM; Stenotrophomonas maltophilia; Life Sciences & Biomedicine; TMP-SMX; Infectious Diseases; levofloxacin
• Research Categories: Health Sciences, Pathology; Biology, Biostatistics

Abstract

Background: Trimethoprim-sulfamethoxazole (TMP-SMX) is considered first-line therapy for Stenotrophomonas maltophilia infections based on observational data from small studies. Levofloxacin has emerged as a popular alternative due to tolerability concerns related to TMP-SMX. Data comparing levofloxacin to TMP-SMX as targeted therapy are lacking. Methods: Adult inpatient encounters January 2005 through December 2017 with growth of S maltophilia in blood and/or lower respiratory cultures were identified in the Cerner Healthfacts database. Patients included received targeted therapy with either levofloxacin or TMP-SMX. Overlap weighting was used followed by downstream weighted regression. The primary outcome was adjusted odds ratio (aOR) for in-hospital mortality or discharge to hospice. The secondary outcome was number of days from index S maltophilia culture to hospital discharge. Results: Among 1581 patients with S maltophilia infections, levofloxacin (n = 823) displayed statistically similar mortality risk (aOR, 0.76 [95% confidence interval {CI},. 58-1.01]; P = .06) compared to TMP-SMX (n = 758). Levofloxacin (vs TMP-SMX) use was associated with a lower aOR of death in patients with lower respiratory tract infection (n = 1452) (aOR, 0.73 [95% CI,. 54-.98]; P = .03) and if initiated empirically (n = 89) (aOR, 0.16 [95% CI,. 03-.95]; P = .04). The levofloxacin cohort had fewer hospital days between index culture collection and discharge (weighted median [interquartile range], 7 [4-13] vs 9 [6-16] days; P < .0001). Conclusions: Based on observational evidence, levofloxacin is a reasonable alternative to TMP-SMX for the treatment of bloodstream and lower respiratory tract infections caused by S maltophilia.