Antibiotic treatment for Stenotrophomonas maltophilia in people with cystic fibrosis

Stenotrophomonas maltophilia is a bacteria which is resistant to several antibiotics. Over the last 10 years this bacteria has increasingly been found in the lungs of people with cystic fibrosis. Chronic infection with Stenotrophomonas maltophilia has been found to be linked to pulmonary infections. However, at present, it is unclear if people with cystic fibrosis should be treated for this bacteria when it is grown in their lungs. The purpose of this review is to determine if treatment with different antibiotic combinations for Stenotrophomonas maltophilia will improve lung function or decrease the frequency of hospital admission in people with cystic fibrosis. We also want to review the effect of treatment of chronic Stenotrophomonas maltophilia infection in order to clear this bacteria from the lungs of a person with cystic fibrosis. We did not find any randomized controlled trials which we could include in the review. We did find one trial of antibiotic treatment for pulmonary exacerbations which included patients with Stenotrophomonas maltophilia, but the patients in the trial also had infections caused by other bacteria and we were not able to obtain data separately for the different causes of infection. Randomized controlled trials are needed to inform clinicians as to whether they should treat Stenotrophomonas maltophilia infection in people with cystic fibrosis. In the meantime, clinicians should use their clinical judgement when considering this question.

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 patients with cystic fibrosis. Randomized clinical trials are needed to address these unanswered clinical questions.

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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.

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 strategy: 

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: 20 February 2014.

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 study of antibiotic treatment of pulmonary exacerbations that included cystic fibrosis patients with Stenotrophomonas maltophilia. However, this study had to be excluded because data was not available per pathogen.