Cefiderocol for Stenotrophomonas maltophilia infections: real-world evidence from a multicenter study and a comprehensive literature review

Stenotrophomonas maltophilia is an opportunistic multidrug-resistant pathogen increasingly associated with severe infections. Although cefiderocol has demonstrated potent in-vitro activity against S. maltophilia, clinical evidence remains limited. We performed a retrospective multicenter study including adult patients with S. maltophilia infections treated with cefiderocol in three tertiary-care hospitals between 2021-2024. Primary outcomes were 30-day mortality, clinical cure, microbiological eradication, and treatment-related adverse events. A review of the available literature was conducted. Fourteen patients were included (median age 61 years; median Charlson Comorbidity Index 5). Pneumonia was the most common infection (50%), while polymicrobial infections occurred in 42.9% of cases. TMP-SMX resistance was observed in 35.7% of isolates. Clinical cure and microbiological eradication were achieved in 64.3% and 75% of patients, respectively, whereas 30-day mortality was 21.4%. No cefiderocol-related adverse events were reported. These findings support cefiderocol as an effective and well-tolerated option for S. maltophilia infections, particularly when conventional therapies are limited.