Cefiderocol Efficacy in a Real-Life Setting: Single-Centre Retrospective Study

Abstract

The current carbapenem-resistant gram-negative bacteria (CR-GN) treatment guidelines lack strong evidence about cefiderocol (CFD) efficacy against CR-GN, especially CRAB. The study’s purpose is to evaluate the effectiveness of CFD in a real-life setting. We made a single-center retrospective study of 41 patients who received CFD in our hospital for several CR-GN infections. Bloodstream infections (BSI) affected 43.9% (18/41) of patients, while CRAB affected 75.6% (31/41) of isolated CR-GN patients. Thirty-days (30-D) all-causes mortality affected 36.6% (15/41) of patients, while end-of-treatment (EOT) clinical cure affected 56.1% (23/41). Finally, microbiological eradication at EOT affected 56.1% (23/41) of patients. Univariate and multivariate analysis showed that septic shock is an independent factor associated with mortality. Subgroup analyses showed no difference in CFD effectiveness between monotherapy and combination therapy.

Cefiderocol and Sulbactam-Durlobactam against Carbapenem-Resistant Acinetobacter baumannii

“…Indeed, in another study [51], FDC was shown to be associated with a higher rate of clinical success in BSI (75%) compared to respiratory infections (45.8%). Similarly, Palermo et al [57] observed a mortality of 61.5% in VAP compared with 46.7% in BSI due to CRAB.…”

“…However, in this study, the reported resistance to FDC was 60% of the tested isolates. Mortality ranged widely, from 12.5% to 51% [50][51][52]57,[60][61][62][63][64][65]. Adverse events associated with FDC administration were very infrequent, being described in none to less than 5% of treated subjects.…”

“…Two multi-center and several single-center studies (Table 3) have assessed the real-life efficacy of FDC in treating CRAB infection [50][51][52][60][61][62][63][64][65], generating similar data to the comparative studies described above. Most of the studies included multiple carbapenemresistant Gram-negatives [52,57,[60][61][62][63]65]. One study, the largest in size, focused only on Acinetobacter spp.…”

“…Infection syndromes included in these studies were mostly BSI and respiratory infections. Clinical cure rates ranged from 32.5% to 77.8% [50,51,57,[60][61][62][63][64][65][66]. Microbiological failure occurred in 0% to 25%.…”

Cefiderocol use for the treatment of infections by carbapenem-resistant Gram-negative bacteria: an Italian multicentre real-life experience

“…At the time of writing this manuscript, consistent real-life experiences of cefiderocol use are increasing but are still limited. 7–10 This study aimed to describe the early experience on cefiderocol postmarketing use at three tertiary care hospitals in Italy, to analyse the predictors of 30 day mortality among patients treated with cefiderocol due to infection with MDR pathogens, and to assess whether the use of cefiderocol-based combinations was associated with different outcomes compared with cefiderocol monotherapy.…”