Ceftazidime-avibactam and aztreonam as a therapeutic alternative in persistent Stenotrophomonas maltophilia bacteremia after allogeneic hematopoietic stem cell transplantation: a case report
DOI:
https://doi.org/10.17843/rpmesp.2026.431.15393Keywords:
Stenotrophomonas maltophilia, hematopoietic stem cell transplantation, ceftazidime-avibactam, aztreonam, febrile neutropeniaAbstract
Stenotrophomonas maltophilia infection represents a therapeutic challenge in immunocompromised patients,
particularly during hematologic recovery after hematopoietic stem cell transplantation (HSCT). The use of trimethoprim–sulfamethoxazole (TMP-SMX), the first-line antimicrobial therapy, is contraindicated due to its hematologic toxicity. We present the case of a patient who underwent haploidentical HSCT and developed two episodes of S. maltophilia bacteremia on days +20 and +49. Given the contraindication to TMP-SMX because of severe myelosuppression, a combination of ceftazidime–avibactam and aztreonam was used as alternative therapy, achieving clinical resolution in both episodes.The patient remained clinically stable until day +100; however, he subsequently developed graft failure and died on day +107 due to VIM-type carbapenemase–producing Pseudomonas aeruginosa.This case suggests that the combination of ceftazidime–avibactam plus aztreonam may be a useful therapeutic option for S. maltophilia infections in post-HSCT patients with contraindications to TMP-SMX.
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Copyright (c) 2025 Wilder Bolaños-Vargas, Cesar Copaja-Corzo, Ivan Fernandez Vertiz, Alfredo Wong-Chang, Miriam Rut Baldeon Laureano
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