Hemodialysis Central Venous Catheter-Associated Bloodstream Infection Caused by Stenotrophomonas maltophilia Treated with Cefiderocol and Levofloxacin After Failure of Trimethoprim–Sulfamethoxazole Monotherapy and Device Replacement

<b>Background</b>: <i>Stenotrophomonas maltophilia</i> infections represent a clinical challenge in treating frail and immunocompromised patients. Alternatives to trimethoprim-sulfamethoxazole (SXT) are needed, with cefiderocol (FDC) representing a promising option, but clinical evidence is limited; moreover, data to support the superiority of mono or combination therapy are lacking. <b>Case presentation</b>: We describe the case of a 55-year-old female patient with a tunneled hemodialysis central venous catheter (HD-CVC)-associated bloodstream infection caused by <i>S. maltophilia</i> that, after failure of a prolonged SXT monotherapy, was successfully treated by HD-CVC replacement followed by intravenous cefiderocol (FDC) and levofloxacin (LVX). <b>Conclusions:</b> FDC represents an interesting option for complex cases of <i>S. maltophilia</i> bloodstream infections, and the combination with LVX might add benefit in cases associated with biofilm formation on intravascular devices.