Antibiotic selection for Stenotrophomonas infections in adults (excluding CNS infections)*^¶

CNS: central nervous system; TMP-SMX: trimethoprim-sulfamethoxazole; UTI: urinary tract infection.

* Before deciding to treat, it is important to differentiate colonization from infection. Treatment of colonization is not recommended.

¶ Treatment selections should be individualized based on patient-specific factors, drug intolerances, and clinical judgment.

Δ In general, mild infections have good source control and no evidence of severe sepsis or septic shock. Pneumonia may be categorized as mild if no systemic symptoms (eg, fever, tachycardia, tachypnea), decrease in baseline oxygenation, or other concerning features are present. Moderate to severe infections either do not meet the criteria for mild infection or have heightened clinical concern.

◊ Minocycline should not be used as monotherapy for UTI or bacteremia.

§ If minocycline and levofloxacin are not options, and TMP-SMX cannot be used due to immunoglobulin (Ig)E-mediated hypersensitivity, we favor rapid desensitization to TMP-SMX if the isolate is susceptible (instead of resorting to other options).

¥ Tigecycline should not be used as monotherapy for UTI, bacteremia, or pneumonia.

‡ Once appropriate clinical response has occurred, antibiotic regimens can be narrowed to a single susceptible agent.