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. 2020 Mar 18;3(3):CD009249.
doi: 10.1002/14651858.CD009249.pub5.

Antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis

Reshma Amin  1 , Nikki Jahnke  2 , Valerie Waters  3
Affiliations

Antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis

Reshma Amin et al. Cochrane Database Syst Rev. .

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: 03 March 2020.

Selection criteria: Randomized controlled trials 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: We 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 no known conflict of interest.

Nikki Jahnke declares no known conflict of interest.

Valerie Waters declares funding from the Cystic Fibrosis Foundation, Cystic Fibrosis Canada, Canadian Institutes of Health Research, Astrazeneca, Innvotech Inc and Gilead Sciences. The funding from Gilead Sciences and Innvotech Inc relate to a laboratory‐based study of biofilm testing.

Clarification statement added from Professor Alan Smyth, Co‐ordinating Editor of the Cystic Fibrosis and Genetic Disorders Review Group on 03 March 2020: Earlier versions of this review were found by the Cochrane Funding Arbiters, post‐publication, to be noncompliant with theCochrane conflict of interest policy, which includes the relevant parts of theCochrane Commercial Sponsorship Policy. The review has now been updated and has a majority of authors and lead author free of conflicts.

Update of

References

References to studies excluded from this review

Aaron 2005 {published data only}
    1. Aaron S, Vandemheen K, Ferris W, Tullis E, Haase D, Berthiaume Y, et al. Treatment of CF exacerbations based on multiple combination antibiotic susceptibility testing-a randomized, double-blind, controlled clinical trial. Pediatric Pulmonolgy 2005;40(Suppl 28):304. [CFGD REGISTER: PI198a]
    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. [CFGD REGISTER: PI198b] - PubMed
EUCTR2014‐003882‐10‐FR {published data only}
    1. EUCTR2014-003882-10-FR. Evaluation of the efficacy of antibiotic treatments associated with the Nebcine® as intravenous injection only and / or monitoring of aerosols of Tobi® in order to optimize the therapeutic management of exacerbations in patients with cystic fibrosis. apps.who.int/trialsearch/Trial2.aspx?TrialID=EUCTR2014-003882-10-FR (first registered 29 July 2015). [CFGD REGISTER: PI313]
NCT01044719 {published data only}
    1. EUCTR2009-014042-28-GB. What duration of intravenous antibiotic therapy should be used in the treatment of infective exacerbations of cystic fibrosis in patients chronically colonised with Pseudomonas aeruginosa? - Duration of antibiotics in infective exacerbations of cystic fibrosis. apps.who.int/trialsearch/Trial2.aspx?TrialID=EUCTR2009-014042-28-GB (first registered 14 October 2010). [CFGD REGISTER: PI314b]
    1. NCT01044719. Duration of antibiotics in infective exacerbations of cystic fibrosis. clinicaltrials.gov/show/NCT01044719 (first posted 08 January 2010). [CFGD REGISTER: PI314a]
Prayle 2016 {published data only}
    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. Pediatric Pulmonology 2013;48 Suppl 36:299. [ABSTRACT NO.: 261] [CENTRAL: 980338] [CFGD REGISTER: CO55a]
    1. Prayle AP, Jain K, Touw DJ, Koch BCP, Knox AJ, Watson A, et al. The pharmacokinetics and toxicity of morning vs. evening tobramycin dosing for. Journal of Cystic Fibrosis 2016;15(4):510-7. [CFGD REGISTER: CO55b] - PMC - PubMed
Singh 2013 {published data only}
    1. Singh SB, Shelton AU, Kotek K, Starner TD. A clinically-embedded trial to evaluate the efficacy of interventions for pre-pseudomonal pathogens. Pediatric Pulmonology 2013;48 Suppl 36:335. [ABSTRACT NO.: 358] [CENTRAL: 999884] [CFGD REGISTER: PI274]
Stockmann 2015 {published data only}
    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. Pediatric Pulmonology 2008;43 Suppl 31:315. [ABSTRACT NO.: 321] [CFGD REGISTER: PI210b]
    1. 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. Journal of Cystic Fibrosis 2008;7(Suppl 2):S26. [CFGD REGISTER: PI210a]
    1. 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. Journal of Cystic Fibrosis 2011;10 Suppl 1:S23. [ABSTRACT NO.: 88] [CENTRAL: 1053535] [CFGD REGISTER: PI210d]
    1. 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] [JID:: 101278196] [PMID: ] - PubMed
STOP‐2 {published data only}
    1. Flume PA, Heltshe SL, West NE, Vandevanter DR, Sanders DB, Skalland M, et al. Design, enrollment, and feasibility of the STOP-2 randomised study of intravenous antibiotic treatment duration in cystic fibrosis pulmonary exacerbations. Journal of Cystic Fibrosis 2018;17 Suppl 3:S85. [CFGD REGISTER: PI298a]
    1. Heltshe S, West NE, VanDevanter DR, Sanders DB, Skalland M, Beckett V, et al. Design, enrollment, and feasibility of the STOP-2 randomised study of iv antibiotic duration in CF pulmonary exacerbations. Pediatric Pulmonology 2017;52 Suppl 47:388. [CFGD REGISTER: PI298b]
    1. Heltshe SL, West NE, VanDevanter DR, Sanders DB, Beckett VV, Flume PA, et al. Study design considerations for the Standardized Treatment of Pulmonary Exacerbations 2 (STOP2): a trial to compare intravenous antibiotic treatment durations in CF. Contemporary clinical trials 2018;64:35-40. [CFGD REGISTER: PI298c] [DOI: 10.1016/j.cct.2017.11.012] - DOI - PMC - PubMed
    1. Sanders DB, Heltshe S, West NE, VanDevanter DR, Skalland M, Flume P, et al. Update on the STOP-2 randomized study of IV antibiotic duration in CF pulmonary exacerbations. Pediatric Pulmonology 2018;53(S2):324. [CFGD REGISTER: PI298d]
    1. West NE. Treatment of pulmonary exacerbations. Pediatric Pulmonology 2017;52(Suppl 47):124-6. [CFGD REGISTER: PI298e]

Additional references

Brooke 2012
    1. Brooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clinical Microbiology Reviews 2012;25(1):2-41. - PMC - PubMed
CFF Registry Data 2018
    1. Cystic Fibrosis Foundation Patient Registry. 2018 patient registry annual data report. www.cff.org/Research/Researcher-Resources/Patient-Registry/2018-Patient-... (accessed 03 March 2020).
CF Registry Data 2018
    1. The Canadian cystic fibrosis registry 2018 annual data report. www.cysticfibrosis.ca/uploads/RegistryReport2018/2018RegistryAnnualDataR... (accessed 03 March 2020).
Dalboge 2011
    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 Fibrosis 2011;10(5):318-25. - PubMed
Deeks 2019
    1. Deeks JJ, Higgins JP, Altman DG, editor(s). Chapter 10: Analysing data and undertaking meta-analyses. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook..
Denton 1998a
    1. Denton M, Todd NJ, Kerr KG, Hawkey PM, Littlewood JM. Molecular epidemiology of Stenotrophomonas maltophilia isolated from clinical specimens from patients with cystic fibrosis and associated environmental samples. Journal of Clinical Microbiology 1998;36(7):1953-8. - PMC - PubMed
Denton 1998b
    1. Denton M, Kerr KG. Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia. Clinical Microbiology Reviews 1998;11(1):57-80. - PMC - PubMed
Donner 2001
    1. Donner A, Piaggio G, Villar J. Statistical methods for the meta-analysis of cluster randomized trials. Statistical Methods in Medical Research 2001;10(5):325-38. - PubMed
Elbourne 2002
    1. Elbourne DR, Altman DG, Higgins JPT, Curtin F, Worthington HV, Vail A. Meta-analyses involving cross-over trials: methodological issues. International Journal of Epidemiology 2002;31(1):140-9. - PubMed
Gee 2000
    1. Gee L, Abbott J, Conway S, Etherington C, Webb A. Development of a disease specific health related quality of life measure for adults and adolescents with cystic fibrosis. Thorax 2000;55(11):946-54. - PMC - PubMed
Gibson 2003
    1. Gibson RL, Burns JL. Pathophysiology and management of pulmonary infections in cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 2003;168(8):918-51. - PubMed
Goss 2002
    1. Goss CH, Otto K, Aitken ML, Rubenfeld GD. Detecting Stenotrophomonas maltophilia does not reduce survival of patients with cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 2002;166(3):356-61. - PubMed
Goss 2004
    1. Goss CH, Mayer-Hamblett N, Aitken ML, Rubenfeld GD, Ramsey BW. Association between Stenotrophomonas maltophilia and lung function in cystic fibrosis. Thorax 2004;59(11):955-9. - PMC - PubMed
Graff 2002
    1. Graff GR, Burns JL. Factors affecting the incidence of Stenotrophomonas maltophilia isolation in cystic fibrosis. Chest 2002;21(6):1754-60. - PubMed
Hanes 2002
    1. Hanes SD, Demirkan K, Tolley E, Boucher BA, Croce MA, Wood GC, et al. Risk factors for late-onset nosocomial pneumonia caused by Stenotrophomonas maltophilia in critically ill trauma patients. Clinical Infectious Diseases 2002;35(3):228-35. - PubMed
Hatziagorou 2019
    1. Hatziagorou E, Orenti A, Drevinek P, Kashirskaya N, Mei-Zahav M, De Boeck K, et al. Changing epidemiology of the respiratory bacteriology of patients with cystic fibrosis-data from the European cystic fibrosis society patient registry. Journal of Cystic Fibrosis 2019 September 03 [Epub ahead of print]. [DOI: 10.1016/j.jcf.2019.08.006] - DOI - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. - PMC - PubMed
Higgins 2017
    1. Higgins JP, Altman DG, Sterne JA, editor(s). Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Churchill R, Chandler J, Cumpston MS, editor(s), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017), Cochrane, 2017. Available from www.training.cochrane.org/handbook..
Higgins 2019
    1. Higgins JP, Li T, Deeks JJ (editors). Chapter 6: Choosing effect measures and computing estimates of effect. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.
Johnson 2003
    1. Johnson C, Butler SM, Konstan MW, Morgan W, Wohl ME. Factors influencing outcomes in cystic fibrosis. A center-based analysis. Chest 2003;123(1):20-7. - PubMed
Kagen 2007
    1. Kagen J, Zaoutis TE, McGowan KL, Luan X, Shah SS. Bloodstream infection caused by Stenotrophomonas maltophilia in children. Pediatric Infectious Disease Journal 2007;26(6):508-12. - PubMed
Marchac 2004
    1. Marchac V, Equi A, Le Bihan-Benjamin C, Hodson M, Bush A. Case-control study of Stenotrophomonas maltophilia acquisition in cystic fibrosis patients. European Respiratory Journal 2004;23(1):98-102. - PubMed
Muder 1996
    1. Muder RR, Harris AP, Muller S, Edmond M, Chow JW, Papadakis K, et al. Bacteremia due to Stenotrophomonas (Xanthomonas) maltophilia: a prospective, multicenter study of 91 episodes. Clinical Infectious Diseases 1996;22(3):508-12. - PubMed
Paez 2008
    1. Paez JI, Tengan FM, Barone AA, Levin AS, Costa SF. Factors associated with mortality in patients with bloodstream infection and pneumonia due to Stenotrophomonas maltophilia. European Journal of Clinical Microbiology and Infectious Diseases 2008;27(10):901-6. - PubMed
Page 2019
    1. Page MJ, Higgins JP, Sterne JA. Chapter 13: Assessing risk of bias due to missing results in a synthesis. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.
Parmar 1998
    1. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Statistics in Medicine 1998;17(24):2815-34. - PubMed
Quittner 2009
    1. Quittner AL, Modi AC, Wainwright C, Otto K, Kirihara J, Montgomery AB. Determination of the minimal clinically important difference scores for the Cystic Fibrosis Questionnaire-Revised respiratory symptom scale in two populations of patients with cystic fibrosis and chronic Pseudomonas aeruginosa airway infection. Chest 2009;135(6):1610-8. - PMC - PubMed
Ramsey 1999
    1. Ramsey BW, Pepe MS, Quan JM, Otto KL, Montgomery AB, Williams-Warren J, et al. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. Cystic Fibrosis Inhaled Tobramycin Study Group. New England Journal of Medicine 1999;340(1):23-30. - PubMed
Rogers 2003
    1. Rogers GB, Hart CA, Mason JR, Hughes M, Walshaw MJ, Bruce KD. Bacterial diversity in cases of lung infection in cystic fibrosis patients: 16S ribosomal DNA (rDNA) length heterogeneity PCR and 16S rDNA terminal restriction fragment length polymorphism profiling. Journal of Clinical Microbiology 2003;41(8):3548-58. - PMC - PubMed
Rosenfeld 2001
    1. Rosenfeld M, Emerson J, Williams-Warren J, Pepe M, Smith A, Montgomery AB, et al. Defining a pulmonary exacerbation in cystic fibrosis. Journal of Pediatrics 2001;139(3):359-65. - PubMed
San Gabriel 2004
    1. San Gabriel P, Zhou J, Tabibi S, Chen Y, Trauzzi M, Saiman L. Antimicrobial susceptibility and synergy studies of Stenotrophomonas maltophilia isolates from patients with cystic fibrosis. Antimicrobial Agents and Chemotherapy 2004;48(1):168-71. - PMC - PubMed
Schünemann 2019
    1. Schünemann HJ, Higgins JP, Vist GE, Glasziou P, Akl EA, Skoetz N, et al. Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. In: Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Available from www.training.cochrane.org/handbook.
Senol 2002
    1. Senol E, DesJardin J, Stark PC, Barefoot L, Snydman DR. Attributable mortality of Stenotrophomonas maltophilia bacteraemia. Clinical Infectious Diseases 2002;34(12):1653-6. - PubMed
Steinkamp 2005
    1. Steinkamp G, Wiedemann B, Rietschel E, Krahl A, Gielen J, Bärmeier H, et al. Prospective evaluation of emerging bacteria in cystic fibrosis. Journal of Cystic Fibrosis 2005;4(1):41-8. - PubMed
Talmaciu 2000
    1. Talmaciu I, Varlotta L, Mortensen J, Schidlow DV. Risk factors for emergence of Stenotrophomonas maltophilia in cystic fibrosis. Pediatric Pulmonology 2000;30(1):10-5. - PubMed
Tsai 2006
    1. Tsai WP, Chen CL, Ko WC, Pan SC. Stenotrophomonas maltophilia bacteraemia in burn patients. Burns 2006;32(2):155-8. - PubMed
VanDevanter 2010
    1. VanDevanter D, O’Riordan M, Blumer J, Konstan M. Assessing time to pulmonary function benefit following antibiotic treatment of acute cystic fibrosis exacerbations. Respiratory Research 2010;11(137):1-8. - PMC - PubMed
Waters 2011
    1. Waters V, Yau Y, Prasad S, Lu A, Atenafu E, Crandall I, et al. Stenotrophomonas maltophilia in cystic fibrosis: serologic response and effect on lung disease. American Journal of Respiratory and Critical Care Medicine 2011;183(5):635-40. - PubMed
Waters 2012
    1. Waters V, Atenafu EG, Salazar JG, Lu A, Yau Y, Matukas L, et al. Chronic Stenotrophomonas maltophilia infection and exacerbation outcomes in cystic fibrosis. Journal of Cystic Fibrosis 2012;11(1):8-13. - PubMed

References to other published versions of this review

Amin 2012
    1. Amin R, Waters V. Antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No: CD009249. [DOI: 10.1002/14651858.CD009249.pub2] - DOI - PubMed
Amin 2014
    1. Amin R, Waters V. Antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No: CD009249. [DOI: 10.1002/14651858.CD009249.pub3] - DOI - PubMed
Amin 2016
    1. Amin R, Waters V. Antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2016, Issue 7. Art. No: CD009249. [DOI: 10.1002/14651858.CD009249.pub4] - DOI - PMC - PubMed

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