Dataset Information

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

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.

SUBMITTER: Sarzynski SH

PROVIDER: S-EPMC8794591 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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

Sarzynski Sadia H SH Warner Sarah S Sun Junfeng J Matsouaka Roland R Dekker John P JP Babiker Ahmed A Li Willy W Lai Yi Ling YL Danner Robert L RL Fowler Vance G VG Kadri Sameer S SS

Open forum infectious diseases 20220117 2

<h4>Background</h4>Trimethoprim-sulfamethoxazole (TMP-SMX) is considered first-line therapy for <i>Stenotrophomonas maltophilia</i> 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.<h4>Methods</h4>Adult inpatient encounters January 2005 through December 2017 with growth of <i>S maltophilia</i> in blood and/or lower res ...[more]

PMID: 35097154

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