Comparative effectiveness of Trimethoprim-Sulfamethoxazole vs. Levofloxacin for Stenotrophomonas maltophilia Bacteremia: Analysis of targeted therapy at 90 US Hospitals, 2000–2014. (4th October 2017)

• Record Type: Journal Article
• Authors: Lai, Yi Ling; Adjemian, Jennifer; Ricotta, Emily; Dekker, John P; Danner, Robert L; Kadri, Sameer S
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S280
• Page End: S281
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.630
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: S. maltophilia is a multi-drug resistant Gram-negative opportunistic pathogen associated with discordant empiric therapy. Most S. maltophilia isolates are susceptible to trimethoprim-sulfamethoxazole (TMP-SMX) and levofloxacin (LVX) by in vitro sensitivity testing, but their relative effectiveness in S. maltophilia bacteremia remains unclear. Methods: Clinical characteristics, in vitro activity and antibiotic therapy were examined for inpatients with S. maltophilia bacteremia in the Cerner Healthfacts database. Treatment was considered targeted if administered within 5 days after S. maltophilia isolation, and empiric if administered 1–5 days prior to isolation. Excluding-resistant isolates, modified Poisson regression was used to estimate the adjusted relative risk (aRR) of therapy choice on mortality, controlling for empiric use, patient and facility-level factors. Results: Of 171, 909 patients with bacteremia from 2000–14, 660 (0.4%) at 102 hospitals had S. maltophilia ; 99% of bloodstream isolates were susceptible to TMP-SMX and 97% to FQs. S. maltophilia bacteremia occurred more frequently in patients at >200 bed, urban and teaching hospitals. Nearly a third had ICU stays and over a third had central venous catheters. Of 600 evaluable patients, 122 (20%) received targeted therapy with TMP-SMX and 107 (18%) with LVX; more patients received targeted LVX in 2010–14 vs.. 2005-09 and vice versa for TMP-SMX. Median age, SOFA scores, Elixhauser comorbidity index and % ICU were comparable between groups. Crude in-hospital mortality was higher in those receiving targeted TMP-SMX (17%) vs. LVX (14%). In adjusted models, mortality risk was 3-fold greater in recipients of targeted TMP-SMX vs. LVX (aRR = 2.9 [1.4-5.8])—and remained significant (aRR = 3.4 [1.1–10.0]) upon excluding recipients of empiric therapy with TMP-SMX or FQ. Conclusion: In a multicenter cohort of patients with S. maltophilia bacteremia, targeted treatment with LVX was associated with a lower relative risk of mortality compared with TMP-SMX, even when these agents were initiated after identification of S. maltophilia in blood cultures. Disclosures: All authors: No reported disclosures.