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Microorganisms
Volume 14
Issue 1
10.3390/microorganisms14010077
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Article

What Drives Mortality in S. maltophilia Bloodstream Infections? An Outcome-Focused Cohort Study of Treatment Strategies and Resistance Profiles

by
Emanuela Zappulo
1,*,
Nicola Schiano Moriello
1,*,
Rossella Paolillo
2,
Giulia Zumbo
1,
Biagio Pinchera
1,
Maria Rosaria Catania
2 and
Ivan Gentile
1
1
Infectious Diseases Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
2
Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy
*
Authors to whom correspondence should be addressed.
Microorganisms 2026, 14(1), 77; https://doi.org/10.3390/microorganisms14010077 (registering DOI)
Submission received: 3 November 2025 / Revised: 11 December 2025 / Accepted: 19 December 2025 / Published: 29 December 2025
(This article belongs to the Collection Feature Papers in Antimicrobial Agents and Resistance)
Versions Notes

Abstract

Stenotrophomonas maltophilia bloodstream infection (SM-BSI) carries high mortality and limited therapeutic options. We conducted a single-center retrospective cohort of adults with first SM-BSI (2018–2024) to describe treatment patterns and identify factors associated with survival. Demographic, clinical, and microbiological data were extracted and analyzed. Forty-three patients were included (median age: 63 years; 61% male). Appropriate antimicrobial therapy was given to 74%; trimethoprim–sulfamethoxazole-based regimens were used in 61%; and combination therapy in 23%. The median time from BSI to treatment initiation was 4 days (IQR: 3–5) and the treatment duration averaged 7 days (IQR: 0–12). Thirty-day mortality was 37% (16/43). The survival analysis found that a 14–21-day course was associated with better 30-day survival than a 7–13-day course (0/9 vs. 5/15 deaths; log-rank p = 0.045), whereas monotherapy and combination therapy did not differ (p = 0.855). Multidrug resistance was linked to worse survival (log-rank p = 0.001). In multivariable models for 30-day mortality, only active treatment (aHR: 0.14; 95% CI: 0.02–0.88) and microbiological cure (aHR: 0.08; 95% CI: 0.01–0.47) remained independently protective. These data suggest that outcomes in SM-BSI are driven primarily by the receipt of appropriate therapy and achievement of microbiological clearance, reinforcing the need for prompt source control, optimized antimicrobial treatment, and continued development of novel therapeutic strategies to improve outcomes in this challenging infection.
Keywords: Stenotrophomonas maltophilia; antimicrobial therapy; treatment duration; microbiological cure; multidrug resistance; Gram-negative bacteria; bacteremia; carbapenem resistance; nosocomial infections; antimicrobial stewardship Stenotrophomonas maltophilia; antimicrobial therapy; treatment duration; microbiological cure; multidrug resistance; Gram-negative bacteria; bacteremia; carbapenem resistance; nosocomial infections; antimicrobial stewardship

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MDPI and ACS Style

Zappulo, E.; Schiano Moriello, N.; Paolillo, R.; Zumbo, G.; Pinchera, B.; Catania, M.R.; Gentile, I. What Drives Mortality in S. maltophilia Bloodstream Infections? An Outcome-Focused Cohort Study of Treatment Strategies and Resistance Profiles. Microorganisms 2026, 14, 77. https://doi.org/10.3390/microorganisms14010077

AMA Style

Zappulo E, Schiano Moriello N, Paolillo R, Zumbo G, Pinchera B, Catania MR, Gentile I. What Drives Mortality in S. maltophilia Bloodstream Infections? An Outcome-Focused Cohort Study of Treatment Strategies and Resistance Profiles. Microorganisms. 2026; 14(1):77. https://doi.org/10.3390/microorganisms14010077

Chicago/Turabian Style

Zappulo, Emanuela, Nicola Schiano Moriello, Rossella Paolillo, Giulia Zumbo, Biagio Pinchera, Maria Rosaria Catania, and Ivan Gentile. 2026. "What Drives Mortality in S. maltophilia Bloodstream Infections? An Outcome-Focused Cohort Study of Treatment Strategies and Resistance Profiles" Microorganisms 14, no. 1: 77. https://doi.org/10.3390/microorganisms14010077

APA Style

Zappulo, E., Schiano Moriello, N., Paolillo, R., Zumbo, G., Pinchera, B., Catania, M. R., & Gentile, I. (2026). What Drives Mortality in S. maltophilia Bloodstream Infections? An Outcome-Focused Cohort Study of Treatment Strategies and Resistance Profiles. Microorganisms, 14(1), 77. https://doi.org/10.3390/microorganisms14010077

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