Treatment and outcomes of difficult-to-treat Stenotrophomonas maltophilia pneumonia in the intensive care unit: a multinational retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Difficult-to-treat resistance (DTR) in Stenotrophomonas maltophilia is an emerging concern in ICU-acquired pneumonia, associated with high mortality and limited evidence to guide therapy. This study aimed to evaluate the association between antibiotic regimens and 30-day mortality in DTR S. maltophilia ICU-acquired pneumonia. We conducted a multicenter, international, retrospective study across 31 centers in eight countries, including all adult patients with DTR S. maltophilia ICU-acquired pneumonia treated with ≥24 hours of an in vitro–active antibiotic. The primary outcome was 30-day mortality. Secondary outcomes included clinical cure and a composite of 30-day survival with clinical cure. Each agent was analyzed as a separate exposure using modified Poisson regression with robust variance in a day-3 landmark cohort. Combination therapy and treatment duration were evaluated using overlap weighting. A total of 119 patients were included. Thirty-day mortality was 37.8%. Tigecycline was associated with higher 30-day mortality (aRR 1.95, 95% CI 1.21–3.13). Aztreonam/ceftazidime-avibactam showed a favorable but non-significant trend toward lower mortality (aRR 0.38, 95% CI 0.12–1.15), as did colistin (aRR 0.51, 95% CI 0.22–1.20). No agent other than tigecycline was significantly associated with any outcome, and the active agents had wide, overlapping confidence intervals. Neither combination therapy nor a treatment duration longer than 8 days was associated with any outcome. Tigecycline was associated with excess mortality and should be used with caution. Aztreonam/ceftazidime-avibactam and colistin trended toward lower mortality, whereas the other agents, including cefiderocol, appeared neutral. The study is underpowered to separate the active agents, and these hypothesis-generating findings require prospective confirmation.
Source: Critical Care
Authors: David Mokrani, Antoine Piantoni, Laurence Drieux-Rouzet, Patricio Ross, Inès Gragueb-Chatti, Marion Giry, Marc Le Pape, Antoine Studer, João Ferreira-Coimbra, Julien Charpentier, Éric Maury, Pierre Bay, Carine Thivilier, Xavier Brousse, Florian Blanchard, Nacim Benchabane, Romaric Larcher, Ignacio Martin-Loeches, Marta Hernández-Meneses, Nicolas Mongardon, Olivier Mascle, Alice Jacquens, Leila S. Hojat, Lukas Antonitsch, Antonio Vena, Giorgia Montrucchio, Marine Amiot, Sophie Nagle, Adrien Bouglé, Alexandre Sitbon, Charles-Edouard Luyt, for the SMR-ICU Study Group, Anahita Rouzé, Caroline Loiez, Jaime Labarca, Sami Hraiech, Fabienne Tamion, Ludovic Lemée, Soumaya Skalli, François Barbier, Maxime Desgrouas, Jérôme Guinard, Ferhat Meziani, Anaïs Curtiaud, Antoine Grillon, Jacques Tankovic, Alexandra Doloy, José Artur Paiva, Edgar Botelho-Moniz, Keyvan Razazi, Jean-Winoc Decousser, Minh-Pierre Lê, Alexandre Boyer, Alicia Silvant, Antoine Monsel, Juliette Chommeloux, Quentin Moyon, Jean-Michel Constantin, Vincent Degos, Bruno Levy, Yann Dumont, Kada Klouche, Anne-Laure Michon, Marie-Noelle Didelot, Alix Pantel, Catia Cilloniz, Antoni Torres, Cristina Pitart, Bertrand Souweine, Renaud Guérin, Eugénie Maurin, Robert A. Bonomo, Maria F. Mojica, Matteo Bassetti, Laura Mezzogori, Antonio Curtoni, Khalil Chaïbi, Françoise Jaureguy, Nicolas Brechot, Isabelle Podglajen, Amira Jomli, Jean-François Timsit, Etienne de Montmollin, Philippe Montravers, Naouale Maataoui, Stéphane Lo, Laurence Armand-Lefèvre, Florent Montini, Carole Schwebel, Anaïs Dartevel, Grégoire Fourcade, Jean-Marc Tadié, Pauline Guillot, Vincent Das, Guillaume Thiery, Gaëtan Plantefève, Khaldoun Kuteifan, Joy Mootien, Alain Gravet, Christophe Guitton, Thomas Douillard, Marc Leone, Marie Fleury, Arnaud Thille, François Arrivé, Florent Bavozet, Philippe Vignon, Jean-Pierre Quenot, Antoine Vieillard-Baron, Matthieu Petit, Alexandra Beurton, Laila Fassi Fihri, Damien Roux, Ilias Karaiskos, Marco Falcone, Giusy Tiseo, Marco Ripa, David Van Duin, Trieu-Vi Khuu
Institutions: Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Centre Hospitalier Universitaire de Lille, Université Pierre-et-Marie-Curie, Pontificia Universidad Católica de Chile, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Université de Rouen Normandie, Centre hospitalier universitaire d'Orléans, Hôpitaux Universitaires de Strasbourg, Hôpital Cochin, Hôpital Saint-Antoine, Inserm, Université Paris-Est Créteil, Hôpitaux Universitaires Henri-Mondor, Institut Mondor de Recherche Biomédicale, Centre Hospitalier Régional et Universitaire de Nancy, Centre Hospitalier Universitaire de Bordeaux, Groupe de recherche clinique en anesthésie réanimation médecine périopératoire, Université de Montpellier, Hôpital Lapeyronie, Centre Hospitalier Universitaire de Nîmes, St. James's Hospital, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Universitat de Barcelona, Centre Hospitalier Universitaire de Clermont-Ferrand, Case Western Reserve University, Danube Private University, Ospedale Policlinico San Martino, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, University of Turin, Hôpital Européen Georges-Pompidou, Hôpital Avicenne, Fondation pour l’innovation en Cadiométabolisme et Nutrition
Language: English
Subfield: Endocrinology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $4,190
OpenAlex ID: W7204154893