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. 2025 Mar;14(3):657-669.
doi: 10.1007/s40121-025-01117-2. Epub 2025 Mar 4.

Cefiderocol for the Treatment of Nosocomial Bloodstream Infections Caused by Stenotrophomonas maltophilia: A Case Series and Literature Review

Antonio Vena  1   2 , Laura Mezzogori #  3   4 , Nadia Castaldo #  5 , Silvia Corcione  6   7 , Renato Pascale  8   9 , Maddalena Giannella  8   9 , Simone Mornese Pinna  6 , Daniele Roberto Giacobbe  3   4 , Davide Fiore Bavaro  10   11   12 , Vincenzo Scaglione  13 , Benedetta Fumarola  14 , Gabriele Pagani  15 , Francesco Giuseppe De Rosa  6 , Michele Bartoletti  11   12 , Matteo Bassetti  3   4 ; SITA GIOVANI (Young Investigators Group of the Società Italiana Terapia Antinfettiva)
Collaborators, Affiliations

Cefiderocol for the Treatment of Nosocomial Bloodstream Infections Caused by Stenotrophomonas maltophilia: A Case Series and Literature Review

Antonio Vena et al. Infect Dis Ther. 2025 Mar.

Abstract

Introduction: The treatment of Stenotrophomonas maltophilia bloodstream infections (BSI) remains challenging due to the organism's intrinsic multidrug resistance and the potential side effects of commonly used first-line antibiotics.

Methods: Here, we describe four cases of S. maltophilia BSI treated with cefiderocol (≥ 72 h) in different Italian hospitals. Additionally, we conducted a PubMed search to identify other studies reporting cases of S. maltophilia BSI managed with cefiderocol.

Results: We reviewed a total of 8 cases of S. maltophilia BSI [median age 52.5 years (Q1-Q3 27.5-61.0), 50% males] treated with cefiderocol, including ours. BSI sources were mainly central venous catheters (62.5%) and the lower respiratory tract (25.0%). Cefiderocol was used as first-line therapy in 87.5% of patients (7/8), with a median treatment duration of 14 days (IQR 6.2-16.0). Combination therapy was administered in 62.5% of cases. Infection source control was required in 75.0% and achieved in 40.0%. Clinical success was observed in 62.5% of patients, with microbiological eradication in 87.5%. In-hospital mortality occurred in 37.5% of cases, with one death directly attributable to S. maltophilia. No significant differences were observed in terms of outcomes between cefiderocol monotherapy and combination therapy.

Conclusions: Based on our findings and a review of the literature, cefiderocol-based regimens show promise as an effective treatment option for S. maltophilia BSI, warranting further investigation in larger studies.

Keywords: Stenotrophomonas maltophilia; Bloodstream infections; Cefiderocol; Multidrug resistance.

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Conflict of interest statement

Declarations. Conflict of Interest: Outside the submitted work, Antonio Vena reports research grants and/or personal fees for advisor/consultant and/or speaker/chairman from Gilead, Menarini, MSD, Pfizer, Astella and Shionogi. Outside the submitted work, Matteo Bassetti reports research grants and/or personal fees for advisor/consultant and/or speaker/chairman from BioMérieux, Cidara, Gilead, Menarini, MSD, Pfizer and Shionogi. Outside the submitted work, Daniele Roberto Giacobbe reports investigator-initiated grants from Pfizer Inc., Shionogi, BioMérieux and Gilead Italia, and personal fees for advisor/speaker from Pfizer Inc., Menarini and Tillotts Pharma. Laura Mezzogori, Nadia Castaldo, Silvia Corcione, Renato Pascale, Maddalena Giannella, Simone Mornese Pinna, Davide Fiore Bavaro, Vincenzo Scaglione, Benedetta Fumarola, Gabriele Pagani, Francesco Giuseppe De Rosa and Michele Bartoletti have nothing to declare. Matteo Bassetti and Daniele Roberto Giacobbe are Editorial Board members of Infectious Diseases and Therapy. Matteo Bassetti and Daniele Roberto Giacobbe were not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Ethical Approval: The study was approved by the institutional review board of the coordinating centre (Comitato Etico interaziendale, City of Health and Sciences, Turin, pratica no. 202/2023, PROT.N. 0066633) and was in accordance with the declaration of Helsinki. Informed consent was deemed unnecessary due to the retrospective nature of the study. STROBE recommendations were followed.

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