Treatment of Multidrug-resistant Gram-Negative Skin and Soft Tissue Infections

Jean-Francois Jabbour; Sima L. Sharara; Souha S. Kanj


Curr Opin Infect Dis. 2020;33(2):146-154. 

In This Article

Management of Stenotrophomonas Maltophilia Skin and Soft Tissue Infection

Stenotrophomonas maltophilia can cause heterogeneous manifestations of SSTI including cellulitis, mucocutaneous ulcers, nonhealing limb and digit ulcers, multifocal purpura and metastatic cellulitis associated with catheter use.[1,79]S. maltophilia infection is mostly seen in immunocompromised patients, patients with chronic pulmonary infections, and critically ill patients.[80,81] Mortality rates associated with S. maltophilia infection have been estimated to be as high as 38%,[82] with even higher rates among immunocompromised patients.[83,84]

S. maltophilia is intrinsically resistant to carbapenems and has become increasingly resistant to many other broad-spectrum antimicrobial agents, including β-lactams, trimethoprim/sulfamethoxazole (TMP-SMX), fluoroquinolones and aminoglycosides.[66,85,86] Current therapy of choice for SSTI includes high-dose TMP-SMX as monotherapy when susceptible, or combination, with ceftazidime, ticarcillin–clavulanate, tetracyclines, and fluoroquinolones, or with combinations or each other, with varying success.[80] Most of the novel antibiotic agents in clinical trials are not active against S. maltophilia.[32] Aztreonam–avibactam has been shown to be active against select clinical strains of S. maltophilia in vitro[87] as avibactam overcomes aztreonam resistance.[87]