title: Monotherapy with minocycline or trimethoprim/sulfamethoxazole for treatment of Stenotrophomonas maltophilia infections.
abstract: OBJECTIVE
  Stenotrophomonas maltophilia is a Gram-negative bacillus intermittently isolated from hospitalized patients. Trimethoprim/sulfamethoxazole is considered the treatment of choice for S. maltophilia infections, though limited by toxicities. Minocycline is utilized at our institution for S. maltophilia infections due to its improved tolerability and in vitro susceptibility rates. Our objective was to evaluate the effectiveness of minocycline monotherapy compared with trimethoprim/sulfamethoxazole monotherapy for treatment of S. maltophilia infections.
  
  
  METHODS
  Patients were identified via microbiology laboratory data and those with at least one positive culture for S. maltophilia were cross-referenced with pharmacy data to detect patients who received trimethoprim/sulfamethoxazole or minocycline. Patients initially receiving combination therapy were excluded. Our primary outcome was treatment failure, defined as receipt of alternative antibiotics with in vitro activity against S. maltophilia, isolation of S. maltophilia on repeat culture or death within 30 days of treatment.
  
  
  RESULTS
  Forty-five patients were evaluated. Overall mortality rate was 9% and equal between groups; 41% of patients (9/22) who received trimethoprim/sulfamethoxazole and 30% (7/23) of patients who received minocycline experienced treatment failure (P = 0.67). Patients who received minocycline were more likely to have had a recent acute kidney injury (AKI) (43.5% versus 9%; P = 0.017) or chronic lung disease (52% versus 9%; P = 0.003). Logistic regression showed consistent results of non-inferiority of the primary outcome when controlling for rates of underlying lung pathology and recent AKI (P = 0.728).
  
  
  CONCLUSIONS
  Treatment failure did not differ between patients receiving trimethoprim/sulfamethoxazole or minocycline monotherapy for treatment of S. maltophilia infections.
authors.affiliation: The University of Texas at Austin College of Pharmacy, Pharmacotherapy Division, Austin, TX, USA The University of Texas Health Science Center at San Antonio, Pharmacotherapy Education & Research Center, San Antonio, TX, USA University Health System, San Antonio, TX, USA oatese3@uthscsa.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hand
authors.affiliation: The University of Texas at Austin College of Pharmacy, Pharmacotherapy Division, Austin, TX, USA The University of Texas Health Science Center at San Antonio, Pharmacotherapy Education & Research Center, San Antonio, TX, USA University Health System, San Antonio, TX, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Davis
authors.affiliation: Methodist Hospital System, San Antonio, TX, USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Kim
authors.affiliation: The University of Texas at Austin College of Pharmacy, Pharmacotherapy Division, Austin, TX, USA The University of Texas Health Science Center at San Antonio, Pharmacotherapy Education & Research Center, San Antonio, TX, USA University Health System, San Antonio, TX, USA.
authors.forename: Bryson
authors.initials: B
authors.lastname: Duhon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D060085:Coinfection; D015897:Comorbidity; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000494:pharmacology / Q000627:therapeutic use*; D012189:Retrospective Studies; D020615:Stenotrophomonas maltophilia / Q000187:drug effects*; D017211:Treatment Failure; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D008911:Minocycline