Levofloxacin reasonable alternative to TMP-SMX for S maltophilia infections: Study

USA: A recent study, based on observational evidence showed that levofloxacin is a reasonable alternative to trimethoprim-sulfamethoxazole (TMP-SMX) for treating bloodstream and lower respiratory tract infections caused by S maltophilia. The study was published in the journal Open Forum Infectious Diseases on 17 January 2022. 

Based on observational data from small studies, TMP-SMX is considered first-line therapy for Stenotrophomonas maltophilia infections. Levofloxacin has emerged as a popular alternative owing to tolerability concerns related to TMP-SMX. There is a lack of data comparing levofloxacin to TMP-SMX as targeted therapy. 

To fill this knowledge gap, Sameer S Kadri, Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA, and colleagues used a large electronic health record database to conduct a retrospective comparative effectiveness study of levofloxacin vs TMP-SMX for BSIs and LRTIs due to S maltophilia using a large electronic health record database. 

For this purpose, the researchers identified adult inpatient encounters from January 2005 through December 2017 with the growth of S maltophilia in blood and/or lower respiratory cultures in the Cerner Health facts database. The patients who were included received targeted therapy with either levofloxacin or TMP-SMX. Overlap weighting was used followed by downstream weighted regression. 

Adjusted odds ratio (aOR) for in-hospital mortality or discharge to hospice was the primary outcome. The secondary outcome was the number of days from index S maltophilia culture to hospital discharge.