{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T15:26:50Z","timestamp":1772638010311,"version":"3.50.1"},"reference-count":27,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Shionogi SRL"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Stenotrophomonas maltophilia infections represent a clinical challenge in treating frail and immunocompromised patients. Alternatives to trimethoprim\u2013sulfamethoxazole (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.<\/jats:p>","DOI":"10.3390\/antibiotics15030265","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T08:51:33Z","timestamp":1772614293000},"page":"265","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemodialysis Central Venous Catheter-Associated Bloodstream Infection Caused by Stenotrophomonas maltophilia Treated with Cefiderocol and Levofloxacin After Failure of Trimethoprim\u2013Sulfamethoxazole Monotherapy and Device Replacement"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8711-8305","authenticated-orcid":false,"given":"Simone","family":"Meini","sequence":"first","affiliation":[{"name":"Internal Medicine Unit, Felice Lotti Hospital of Pontedera, Azienda Unit\u00e0 Sanitaria Locale Toscana Nord-Ovest, 56121 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0295-6877","authenticated-orcid":false,"given":"Alberto","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy"},{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1848-5267","authenticated-orcid":false,"given":"Benedetta","family":"Longo","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, Felice Lotti Hospital of Pontedera, Azienda Unit\u00e0 Sanitaria Locale Toscana Nord-Ovest, 56121 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maddalena","family":"Mura","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, Felice Lotti Hospital of Pontedera, Azienda Unit\u00e0 Sanitaria Locale Toscana Nord-Ovest, 56121 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Andreoli","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Felice Lotti Hospital of Pontedera, Azienda Unit\u00e0 Sanitaria Locale Toscana Nord-Ovest, 56121 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angeliki","family":"Kanaki","sequence":"additional","affiliation":[{"name":"Nefrology Unit, Felice Lotti Hospital of Pontedera, Azienda Unit\u00e0 Sanitaria Locale Toscana Nord-Ovest, 56121 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Grassi","sequence":"additional","affiliation":[{"name":"Nefrology Unit, Felice Lotti Hospital of Pontedera, Azienda Unit\u00e0 Sanitaria Locale Toscana Nord-Ovest, 56121 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Niccolai","sequence":"additional","affiliation":[{"name":"Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy"},{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Viaggi","sequence":"additional","affiliation":[{"name":"ICU Department, Careggi Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9386-0434","authenticated-orcid":false,"given":"Gian Maria","family":"Rossolini","sequence":"additional","affiliation":[{"name":"Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy"},{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1046\/j.1462-5822.2003.00306.x","article-title":"Fimbriae and adherence of Stenotrophomonas maltophilia to epithelial cells and to abiotic surfaces","volume":"5","author":"Rosales","year":"2003","journal-title":"Cell. Microbiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1128\/CMR.00019-11","article-title":"Stenotrophomonas maltophilia: An emerging opportunistic pathogen","volume":"25","author":"Brooke","year":"2012","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e0003019","DOI":"10.1128\/CMR.00030-19","article-title":"Adevances in the microbiology of Stenotrophomonas maltophilia","volume":"34","author":"Brooke","year":"2021","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.2217\/fmb.09.84","article-title":"Attributable mortality of Stenotrophomonas maltophilia infections a systematic review of the literature","volume":"4","author":"Falagas","year":"2009","journal-title":"Future Microbiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e00405-19","DOI":"10.1128\/mBio.00405-19","article-title":"Population structure, molecular epidemiology, and \u03b2-lactamase diversity among Stenotrophomonas maltophilia isolates in the United States","volume":"10","author":"Mojica","year":"2019","journal-title":"mBio"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Tamma, P.D., Heil, E.L., Justo, J.A., Mathers, A.J., Satlin, M.J., and Bonomo, R.A. (2024). Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Clin. Infect. Dis., ciae403.","DOI":"10.1093\/cid\/ciae403"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"R74","DOI":"10.1186\/gb-2008-9-4-r74","article-title":"The complete genome, comparative and functional analysis of Stenotrophomonas maltophilia reveals an organism heavily shielded by drug resistance determinants","volume":"9","author":"Crossman","year":"2008","journal-title":"Genome Biol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.jgar.2021.04.019","article-title":"In vitro activity of cefiderocol and comparators against isolates of Gram-negative pathogens from a range of infection sources: SIDERO-WT-2014\u20132018 studies in Italy","volume":"25","author":"Stracquadanio","year":"2021","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1128\/AAC.00795-06","article-title":"Aph(3\u2032)-IIc, an aminoglycoside resistance determinant from Stenotrophomonas maltophilia","volume":"51","author":"Okazaki","year":"2007","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1093\/jac\/dkp476","article-title":"Novel variants of the Smqnr family of quinolone resistance genes in clinical isolates of Stenotrophomonas maltophilia","volume":"65","author":"Gordon","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3079","DOI":"10.1128\/AAC.44.11.3079-3086.2000","article-title":"Cloning and characterization of SmeDEF, a novel multidrug efflux pump from Stenotrophomonas maltophilia","volume":"44","author":"Alonso","year":"2000","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"105082","DOI":"10.1016\/j.cmicom.2025.105082","article-title":"on behalf of the EUCAST. Rationale for contemporary antimicrobial treatment of Stenotrophomonas maltophilia: A narrative review","volume":"2","author":"Turnidge","year":"2025","journal-title":"CMI Commun."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e01554-24","DOI":"10.1128\/aac.01554-24","article-title":"Evidence of dissemination of a clc-type integrative and conjugative element to Stenotrophomonas maltophilia, mediating acquisition of sul1 and other resistance determinants","volume":"69","author":"Boncompagni","year":"2025","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1093\/jac\/dkn301","article-title":"Therapeutic options for Stenotrophomonas maltophilia infections beyond co-trimoxazole: A systematic review","volume":"62","author":"Falagas","year":"2008","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_15","unstructured":"(2025, November 28). Available online: https:\/\/www.eucast.org\/fileadmin\/eucast\/pdf\/breakpoints\/v_15.0_Breakpoint_Tables.pdf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1128\/AAC.01682-13","article-title":"Can levofloxacin be a useful alternative to trimethoprim-sulfamethoxazole for treating Stenotrophomonas maltophilia bacteremia?","volume":"58","author":"Cho","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"ofab644","DOI":"10.1093\/ofid\/ofab644","article-title":"Trimethoprim-Sulfamethoxazole Versus Levofloxacin for Stenotrophomonas maltophilia Infections: A Retrospective Comparative Effectiveness Study of Electronic Health Records from 154 US Hospitals","volume":"9","author":"Sarzynski","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"83","DOI":"10.2217\/fmb-2020-0115","article-title":"Effect of antimicrobials on Stenotrophomonas maltophilia biofilm","volume":"16","author":"Souza","year":"2021","journal-title":"Future Microbiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.diagmicrobio.2019.03.003","article-title":"Reproducibility of broth microdilution MICs for the novel siderophore cephalosporin, cefiderocol, determined using iron-depleted cation-adjusted Mueller-Hinton broth","volume":"94","author":"Hackel","year":"2019","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1093\/jac\/dkac142","article-title":"Activity of fosfomycin\/colistin combinations against planktonic and biofilm Gram-negative pathogens","volume":"77","author":"Boncompagni","year":"2022","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.bcp.2019.03.001","article-title":"The FICI paradigm: Correcting flaws in antimicrobial in vitro synergy screens at their inception","volume":"163","year":"2019","journal-title":"Biochem. Pharmacol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1093\/jac\/11.5.427","article-title":"The fractional inhibitory concentration (FIC) index as a measure of synergy","volume":"11","author":"Hall","year":"1983","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.dmpk.2017.11.314","article-title":"Quantitative analysis of elevation of serum creatinine via renal transporter inhibition by trimethoprim in healthy subjects using physiologically-based pharmacokinetic model","volume":"33","author":"Nakada","year":"2018","journal-title":"Drug Metab. Pharmacokinet."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1159\/000013483","article-title":"Trimethoprim-sulfamethoxazole therapy in outpatients: Is hyperkalemia a significant problem?","volume":"19","author":"Alappan","year":"1999","journal-title":"Am. J. Nephrol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3187","DOI":"10.1093\/jac\/dkac304","article-title":"Trimethoprim\/sulfamethoxazole pharmacodynamics against Stenotrophomonas maltophilia in the in vitro chemostat model","volume":"77","author":"Lasko","year":"2022","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1093\/cid\/ciab1013","article-title":"Infectious Diseases Society of America Guidance on the Treatment of AmpC \u03b2-Lactamase-producing Enterobacterales, Carbapemen-Resistant Acinetobacter baumaannii, and Stenotrophomonas maltophilia Infections","volume":"74","author":"Tamma","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1038\/ja.2015.27","article-title":"In vitro activity of fosfomycin in combination with colistin against clinical isolates of carbapenem-resistant Pseudomas aeruginosa","volume":"68","author":"Di","year":"2015","journal-title":"J. Antibiot."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/3\/265\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T09:27:23Z","timestamp":1772616443000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/3\/265"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,4]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["antibiotics15030265"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15030265","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,4]]}}}