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. 2016 Jul 14;7(7):CD009249.
doi: 10.1002/14651858.CD009249.pub4.

Antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis

Reshma Amin  1 , Valerie Waters
Affiliations

Antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis

Reshma Amin et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Stenotrophomonas maltophilia is one of the most common emerging multi-drug resistant organisms found in the lungs of people with cystic fibrosis and its prevalence is increasing. Chronic infection with Stenotrophomonas maltophilia has recently been shown to be an independent predictor of pulmonary exacerbation requiring hospitalization and antibiotics. However, the role of antibiotic treatment of Stenotrophomonas maltophilia infection in people with cystic fibrosis is still unclear. This is an update of a previously published review.

Objectives: The objective of our review is to assess the effectiveness of antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis. The primary objective is to assess this in relation to lung function and pulmonary exacerbations in the setting of acute pulmonary exacerbations. The secondary objective is to assess this in relation to the eradication of Stenotrophomonas maltophilia.

Search methods: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched a registry of ongoing trials and the reference lists of relevant articles and reviews.Date of latest search: 27 May 2016.

Selection criteria: Any randomized controlled trial of Stenotrophomonas maltophilia mono-infection or Stenotrophomonas maltophilia co-infection with Pseudomonas aeruginosa in either the setting of an acute pulmonary exacerbation or a chronic infection treated with suppressive antibiotic therapy.

Data collection and analysis: Both authors independently assessed the trials identified by the search for potential inclusion in the review.

Main results: The initial search strategy identified only one trial of antibiotic treatment of pulmonary exacerbations that included people with cystic fibrosis with Stenotrophomonas maltophilia. However, this trial had to be excluded because data was not available per pathogen.

Authors' conclusions: This review did not identify any evidence regarding the effectiveness of antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis. Until such evidence becomes available, clinicians need to use their clinical judgement as to whether or not to treat Stenotrophomonas maltophilia infection in people with cystic fibrosis. Randomized clinical trials are needed to address these unanswered clinical questions.

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Conflict of interest statement

Reshma Amin declares she has received funding from Novartis for an investigator‐run clinical trial which is OUTSIDE the scope of this Cochrane review.

Val Waters declares that Innvotech Inc funded the biofilm trial; a randomized controlled trial of the use of biofilm antimicrobial susceptibility testing in CF on which she worked. She also has received a CF Canada grant to investigate the role of epidemic Pseudomonas aeruginosa in CF.

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References

References to studies excluded from this review

    1. Aaron SD, Vandemheen KL, Ferris W, Ferguson D, Tullis E, Haase D, et al. Combination antibiotic susceptibility testing to treat exacerbations of cystic fibrosis associated with multiresistant bacteria: a randomized, double‐blind, controlled clinical trial. Lancet 2005;366(9484):463‐71. - PubMed
    1. Prayle A, Jain K, Watson A, Smyth AR. Are morning doses of intravenous tobramycin less nephrotoxic than evening? Evidence from urinary biomarkers in the critic study [abstract]. Pediatric Pulmonology 2013;48 Suppl 36:299, Abstract no: 261. [CENTRAL: 980338; CFGD Register: CO55; CRS: 5500125000000420; ]
    1. Singh SB, Shelton AU, Kotek K, Starner TD. A clinically‐embedded trial to evaluate the efficacy of interventions for pre‐pseudomonal pathogens [abstract]. Pediatric Pulmonology 2013;48 Suppl 36:335, Abstract no: 358. [CENTRAL: 999884; CFGD Register: PI274; CRS: 5500127000000006; ]
    1. Geller DE, Flume P, Schwab R, Fornos P, Conrad DJ, Morgan E, et al. A phase 1 safety, tolerability and pharmacokinetic (PK) study of MP‐376 (levofloxacin solution for inhalation) in stable cystic fibrosis (CF) patients [abstract]. Pediatric Pulmonology 2008;43 Suppl 31:315, Abstract no: 321. [CFGD Register: PI210b; ]
    2. Griffith DC, Hansen C, Pressler T, Balchen T, Jensen TJ, Geller DE, et al. Single‐dose pharmacokinetics of aerosol MP‐376 (levofloxacin solution for inhalation) in cystic fibrosis patients: PK‐PD implications [abstract]. Journal of Cystic Fibrosis 2008;7(Suppl 2):S26. [CFGD Register: PI210a; ]
    3. Kearns GL, Rubino CM, Griffith DC, Geller DE, Forrest A, Bhavnani SM, et al. Levofloxacin pharmacokinetics (PK) after administration of MP‐376 (Levofloxacin inhalation solution; Aeroquin) in children with cystic fibrosis [abstract]. Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society 2011;10 Suppl 1:S23, Abstract no: 88. [CENTRAL: 1053535; CFGD Register: PI210d; CRS: 5500133000000015; ]
    4. Stockmann C, Hillyard B, Ampofo K, Spigarelli MG, Sherwin CM. Levofloxacin inhalation solution for the treatment of chronic Pseudomonas aeruginosa infection among patients with cystic fibrosis. Expert Review of Respiratory Medicine 2015;9(1):13‐22. [CENTRAL: 1053533; CFGD Register: PI210c; CRS: 5500131000000314; JID:: 101278196; PUBMED: 25417708] - PubMed

Additional references

    1. Ballestero S, Vírseda I, Escobar H, Suárez L, Baquero F. Stenotrophomonas maltophilia in cystic fibrosis patients. European Journal of Clinical Microbiology and Infectious Diseases 1995;14(8):728‐9. - PubMed
    1. Brooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clinical Microbiology Reviews 2012;25(1):2‐41. - PMC - PubMed
    1. Canadian CF Patient Data Registry Report (CDPR). Annual Data Report2002.
    1. Cystic Fibrosis Foundation Patient Registry. 2002 Annual Data Report to the Center Directors2003.
    1. Dalboge CS, Hansen CR, Pressler T, Høiby N, Johansen HK. Chronic pulmonary infection with Stenotrophomonas maltophilia and lung function in patients with cystic fibrosis. Journal of Cystic Fibrosis2011; Vol. 10, issue 5:318‐25. - PubMed

References to other published versions of this review

    1. Amin R, Waters V. Antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2012, Issue 5. [DOI: 10.1002/14651858.CD009249.pub2] - DOI - PubMed
    1. Amin R, Waters V. Antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2014, Issue 4. [DOI: 10.1002/14651858.CD009249.pub3] - DOI - PubMed

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