# Hemodialysis Central Venous Catheter-Associated Bloodstream Infection Caused by Stenotrophomonas maltophilia Treated with Cefiderocol and Levofloxacin After Failure of Trimethoprim–Sulfamethoxazole Monotherapy and Device Replacement

## TL;DR

A patient with a bloodstream infection caused by Stenotrophomonas maltophilia was successfully treated with cefiderocol and levofloxacin after other treatments failed.

## Contribution

This case highlights the potential effectiveness of cefiderocol combined with levofloxacin for treating S. maltophilia infections.

## Key findings

- Trimethoprim–sulfamethoxazole monotherapy failed to treat the infection.
- Cefiderocol and levofloxacin successfully treated the bloodstream infection after catheter replacement.
- Combination therapy may be beneficial in biofilm-related infections.

## Abstract

Background: Stenotrophomonas maltophilia infections represent a clinical challenge in treating frail and immunocompromised patients. Alternatives to trimethoprim–sulfamethoxazole (SXT) are needed, with cefiderocol (FDC) representing a promising option, but clinical evidence is limited; moreover, data to support the superiority of mono or combination therapy are lacking. Case presentation: We describe the case of a 55-year-old female patient with a tunneled hemodialysis central venous catheter (HD-CVC)-associated bloodstream infection caused by S. maltophilia that, after failure of a prolonged SXT monotherapy, was successfully treated by HD-CVC replacement followed by intravenous cefiderocol (FDC) and levofloxacin (LVX). Conclusions: FDC represents an interesting option for complex cases of S. maltophilia bloodstream infections, and the combination with LVX might add benefit in cases associated with biofilm formation on intravascular devices.