Combination Therapy Versus Monotherapy In The Treatment Of Stenotrophomonas Maltophilia Infections: A Systematic Review And Meta-Analysis

Abstract Background: Stenotrophomonas maltophilia is a multidrug-resistant bacteria that is difficult to treat in hospitals around the world. It has become a public health issue, as well as being linked to a high mortality rate. Several studies have shown a variety of treatment and clinical outcomes; however, the efficacy of combination therapy remains limited. Therefore, the purpose of this study is to investigate the effect of monotherapy and combination therapy for S. maltophilia infections on mortality outcome.Methods: We performed a systematic review and meta-analysis of combination therapy versus monotherapy in the treatment of S. maltophilia infections on mortality as a clinical outcome. Electronic databases, including Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, Scopus, and OpenGrey, were systematically searched from the inception of the database until September 3, 2021. Results: Of which 6,524 articles identified, a total of 13 studies and 2 cohort studies were included for systematic review of combination therapy and meta-analysis, respectively. The systematic review of combination antimicrobial therapy had been showed clinically desirable outcome on mortality in S. maltopholia infection, especially in complex or severe infection. In the fixed-effects meta-analysis of the cohort study, monotherapy was surprisingly shown to have statistically significant effects on the decreased risk of mortality (hazard ratio 1.42; 95% confidence interval, 1.04-1.94). Conclusions: Our results found that the combination antimicrobial therapy had been showed clinically desirable outcome on mortality in S. maltopholia infection and monotherapy has a trend toward improved better outcome than combination therapy on mortality for the treatment of S. maltophilia infections. A longitudinal study that further explores this association is warranted. Trial registration: This study was registered with the trial registration number ID: 210843 under the international prospective register of systematic reviews (PROSPERO: www.crd.york.ac.uk/PROSPERO).