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Stenotrophomonas maltophilia is an increasingly common Gram-negative pathogen with high lethality when it causes invasive disease. While trimethoprim/sulfamethoxazole is the treatment of choice, the real-world use of this regimen is complicated by the requisite high doses. Fluoroquinolones like levofloxacin are often chosen as better-tolerated options, but the susceptibility breakpoints have not been validated. Furthermore, while levofloxacin breakpoints against S. maltophilia have paralleled those for Pseudomonas aeruginosa and Enterobacterales, the fluoroquinolone breakpoints against these pathogens have been lowered recently — but remain unchanged against S. maltophilia.
Fratoni et al. utilized a murine thigh infection model to evaluate h…