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.
Based on the findings, the researchers found the following:
- Among 1581 patients with S maltophilia infections, levofloxacin (n = 823) displayed statistically similar mortality risk (aOR, 0.76 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) and if initiated empirically (n = 89) (aOR, 0.16).
- The levofloxacin cohort had fewer hospital days between index culture collection and discharge (weighted median, 7 vs 9 days).
"Based on observational evidence we found that levofloxacin is a reasonable alternative to TMP-SMX for the treatment of bloodstream and lower respiratory tract infections caused by S maltophilia," wrote the authors.
"Consider levofloxacin in patients with diagnosed S maltophilia infections sensitive to TMP-SMX tolerability limitations, especially those who are neutropenic, critically ill," they concluded.
Reference:
Sadia H Sarzynski, Sarah Warner, Junfeng Sun, Roland Matsouaka, John P Dekker, Ahmed Babiker, Willy Li, Yi Ling Lai, Robert L Danner, Vance G Fowler, Jr, Sameer S Kadri, for the National Institutes of Health Antimicrobial Resistance Outcomes Research Initiative, Trimethoprim-Sulfamethoxazole Versus Levofloxacin for Stenotrophomonas maltophilia Infections: A Retrospective Comparative Effectiveness Study of Electronic Health Records from 154 US Hospitals, Open Forum Infectious Diseases, Volume 9, Issue 2, February 2022, ofab644, https://doi.org/10.1093/ofid/ofab644
