P-1358. Efficacy of combination therapy with minocycline for the treatment of Stenotrophomonas maltophilia infections

TL;DR

Combining minocycline with other antibiotics improved microbiological outcomes but not survival in patients with Stenotrophomonas maltophilia infections.

Contribution

This study is the first to evaluate the efficacy of minocycline-based combination therapy for S. maltophilia infections in a randomized clinical trial.

Findings

Combination therapy with minocycline showed significantly better microbiological outcomes than monotherapy.

There was no significant difference in 28-day mortality between combination and monotherapy groups.

Adverse events were common but not directly linked to the study drugs.

Abstract

Stenotrophomonas maltophilia is a multidrug-resistant bacterium that causes high in-hospital mortality worldwide. However, published data on the utility of combination therapy for S. maltophilia infections remain limited.

We enrolled adult patients with S. maltophilia infection in a randomized, double-blind, placebo-controlled, single-center clinical trial at Siriraj Hospital, Thailand. Patients were assigned 1:1 to receive minocycline capsules (100 mg twice daily) in combination with either levofloxacin or trimethoprim-sulfamethoxazole or monotherapy with either levofloxacin or trimethoprim-sulfamethoxazole. The study outcomes were 28-day mortality, clinical and microbiological responses, and adverse events. The favorable microbiological outcome was that the previously identified pathogen was not detected, and no new pathogen was detected.

Between 2022 and 2024, 112 patients were randomly assigned to combination therapy (n = 55) or monotherapy (n = 57). Most patients were in the intensive care unit at the time of enrollment (71.4%). There was no difference in 28-day mortality between groups (43.6% combination therapy vs 38.6% monotherapy, p = 0.59). Patients on combination therapy had significantly more favorable microbiological outcomes than patients on monotherapy 72 hours after treatment (45.5% on combination therapy vs 14% on monotherapy, p < 0.001) and at the end of treatment (80% on combination therapy vs 56.1% on monotherapy, p = 0.023). However, we observed comparable favorable clinical response rates 72 hours after treatment and at the end of treatment (52.7% on combination therapy vs 42.1% on monotherapy, p = 0.30, and 54% on combination therapy vs 57% on monotherapy, p = 0.86, respectively). Acute kidney injury was independently associated with 28-day mortality per a multivariate analysis. Adverse events, including acute kidney injury (n = 65/112; 58%) and elevated liver enzymes (n = 8/112; 7%), occurred but were not related to the study drug.

Combination therapy with minocycline had better microbiological efficacy than monotherapy in patients with S. maltophilia infection and was safe. However, a beneficial effect of combination therapy with minocycline on the clinical outcomes of S. maltophilia infections was not noted.

All Authors: No reported disclosures