How do I manage a patient with Stenotrophomonas maltophilia infection?

Background: Stenotrophomonas maltophilia is a Gram-negative bacillus that may cause a range of infections, most frequently bloodstream and respiratory infections. S. maltophilia exhibits intrinsic resistance to several antibiotics including carbapenems. Clinical assessment and treatment of a patient with positive S. maltophilia cultures are challenging. Objectives: We aimed to provide a resource for clinicians to help diagnose and treat S. maltophilia infections. Sources: A comprehensive literature search on S. maltophilia infections was conducted using PubMed, with no restrictions on publication date. Content: The review uses a hypothetical clinical vignette as a context to explore the epidemiology, risk factors, clinical presentation, mortality, diagnostic management, antibiotic resistance mechanisms, and antibiotic management of S. maltophilia infections. Implications: The assessment and treatment of S. maltophilia infections remain challenging. Standardized indications to distinguish colonization from infection and to guide the start of targeted therapy are lacking. The optimal treatment approach has similarly not been established in randomized controlled trials.