Stenotrophomonas maltophilia in people with Cystic Fibrosis: a systematic review of prevalence, risk factors and management

Abstract

To summarize the current knowledge of the clinical impact of Stenotrophomonas maltophilia (SM) in cystic fibrosis (CF) patients. A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline recommendations, was performed through searches in PubMed and EMBASE databases, and CF National and International Registries websites from 2000 to 2022. Overall, 184 articles were initially retrieved, out of which 15 were selected and included in the review. Data form 6 Registries and 9 pertinent articles from the references of the studies selected were also considered, resulting in 30 studies in total. The prevalence of SM in patients with CF is increasing in Europe while it is declining in North America. The role of chronic colonization of SM on lung function and clinical status in CF patients is still under debate. The most recent studies suggested a pathogenic role of SM chronic infections in CF patients with an acceleration in lung function decline, an increase in hospitalization rates and an association with co-infection. Reflecting the uncertainty about the role of SM in CF, little is available about antibiotic therapeutic strategies for both acute exacerbations and chronic infections. Antimicrobial therapy should be performed in the acute exacerbations, while it may be reasonable to attempt eradication when the first colonization is identified. Nevertheless, it is not established which antibiotic regimen should be preferred, and overtreatment could contribute to the selection of antimicrobial-resistant strains. Further studies are warranted in this regard.

Keywords: Antimicrobial therapy; Lung function; Prevalence; Risk factors; Systematic review.

Fig. 1

Flow diagram of literature search and data extraction

Fig. 2

Prevalence of Stenotrophomonas maltophilia in adults and children with Cystic Fibrosis by Country. (1) Data from the 2021 Canadian Cystic Fibrosis Registry; (2) data from the 2021 Cystic Fibrosis Foundation Patient Registry; (3) data from the 2021 European Cystic Fibrosis Society Patient Registry; (4) data from the 2020 Italian Cystic Fibrosis Registry; (5) data from the 2021 Australian Cystic Fibrosis Data Registry