Stenotrophomonas maltophilia (SM) bloodstream infections pose a significant mortality risk in patients with hematologic malignancy and those undergoing hematopoietic stem cell transplantation. In a single center cohort study published in Annals of Hematology, Emily L. Gill, PharmD, and colleagues aimed to develop a risk score to predict SM infections, potentially reducing time to appropriate antimicrobial therapy (TTAT) and improving patient outcomes. They assessed 36 patients with SM and 534 patients without SM who had Gram-negative bloodstream infections. The initial StenoSCORE (≥33 points) was 80% sensitive and 68% specific, accurately classifying 69% of Gram-negative bloodstream infections. The refined StenoSCORE2, incorporating risk factors such as acute leukemia, prolonged neutropenia, mucositis, ICU admission, and recent meropenem/cefepime exposure, showed improved performance (ROC AUC, 0.84 vs 0.77). A StenoSCORE2 ≥4 points was 86% sensitive and 76% specific, accurately classifying 77% of Gramnegative bloodstream infections. TTAT was significantly longer for patients with SM infections, with higher in-hospital and 28-day mortality rates.