Published August 3, 2025 | Version v1
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Terapia combinada antibiótica en infecciones por Stenotrophomonas maltophilia: Impacto clínico

Authors/Creators

  • 1. Departamento de Agentes Biológicos, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, México

Description

Resumen

Introducción: Stenotrophomonas maltophilia (S. maltophilia) es un patógeno oportunista responsable de infecciones leves y graves, cuyo tratamiento se ve complicado por su resistencia intrínseca antibiótica. La terapia combinada con trimetoprima/sulfametoxazol es el tratamiento de primera línea, aunque en casos de resistencia o intolerancia, se emplean alternativas.

Objetivo: Esta revisión bibliográfica tiene como objetivo evaluar el impacto clínico de la terapia combinada antibiótica en el tratamiento de infecciones causadas por S. maltophilia.

Métodos: Se realizó una búsqueda bibliográfica y se seleccionaron artículos con enfoque en la antibioticoterapia combinada contra infecciones por S. maltophilia. De los 72 estudios encontrados, se incluyeron 33 que cumplían los criterios de selección.

Resultados: Las guías de tratamiento recomiendan cotrimoxazol y minociclina para infecciones leves y combinaciones de cotrimoxazol con otros antibióticos para infecciones graves. La combinación de ceftazidima/avibactam (CZA/ATM) y aztreonam ha mostrado sinergia en cepas resistentes, inhibiendo β-lactamasas y mejorando la actividad bactericida. La terapia combinada ha mejorado los resultados en infecciones graves, como bacteriemia, donde cefiderocol o trimetoprim/sulfametoxazol son efectivos. Sin embargo, la nefrotoxicidad sigue siendo un riesgo en infecciones respiratorias y oftalmológicas. Factores como resistencia antimicrobiana, toxicidad acumulativa y efectos adversos afectan el éxito terapéutico. La falta de actualización en las pruebas de susceptibilidad dificulta la selección de antibióticos. Nuevas perspectivas incluyen la inhibición de bombas de eflujo, bacteriófagos y productos naturales, así como el desarrollo de nuevas moléculas como minociclina y cefiderocol.

Conclusión: El tratamiento de infecciones por S. maltophilia sigue siendo un desafío, sin embargo, las terapias combinadas han demostrado ser una estrategia eficaz. La combinación de antibióticos como cotrimoxazol, minociclina, cefiderocol y el uso de opciones emergentes como CZA/ATM y bacteriófagos han mostrado un impacto positivo en la reducción de la mortalidad y la duración de la hospitalización.

 

Abstract

Background: Stenotrophomonas maltophilia (S. maltophilia) is an opportunistic pathogen responsible for both mild and severe infections, and its treatment is complicated by its intrinsic antibiotic resistance. The combination therapy with trimethoprim/sulfamethoxazole is the first-line treatment, although alternatives are used in cases of resistance or intolerance.

Objective: This literature review aims to evaluate the clinical impact of combination antibiotic therapy in the treatment of infections caused by S. maltophilia.

Methods: A literature search was conducted, and articles focusing on combination antibiotic therapy for S. maltophilia infections were selected. Of the 72 studies found, 33 that met the selection criteria were included.

Results: Treatment guidelines recommend cotrimoxazole and minocycline for mild infections, and combinations of cotrimoxazole with other antibiotics for severe infections. The combination of ceftazidime/avibactam (CZA/ATM) and aztreonam has shown synergy in resistant strains, inhibiting β-lactamases and enhancing bactericidal activity. Combination therapy has improved outcomes in severe infections, such as bacteremia, where cefiderocol or trimethoprim/sulfamethoxazole are effective. However, nephrotoxicity remains a risk in respiratory and ophthalmic infections. Factors such as antimicrobial resistance, cumulative toxicity, and adverse effects impact therapeutic success. The lack of updated susceptibility testing hinders appropriate antibiotic selection. New perspectives include inhibition of efflux pumps, bacteriophage therapy, and natural products, as well as the development of new molecules such as minocycline and cefiderocol.

Conclusion: Treatment of S. maltophilia infections remains a challenge, yet combination therapies have proven to be an effective strategy. The combination of antibiotics like cotrimoxazole, minocycline, and cefiderocol, along with emerging options such as CZA/ATM and bacteriophages, has shown a positive impact in reducing mortality and shortening hospital stays.

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