Abstract
Multi-drug resistant gram-negative bacteria present a significant global health threat. Cefiderocol (CFDC), a siderophore cephalosporin, has shown potential in combating this threat, but with the currently available data, its role in therapy remains poorly defined. This multi-center, retrospective cohort study evaluated the real-world application of CFDC across six U.S. medical centers from January 2018 to May 2023. Patients aged ≥18 years and who had received ≥72 hours of CFDC were included. The primary outcome was a composite of clinical success: survival at 30 days, absence of symptomatic microbiologic recurrence at 30 days following CFDC treatment initiation, and resolution of signs and symptoms. Secondary outcomes included time to CFDC therapy and on-treatment non-susceptibility to CFDC. A total of 112 patients were included, with median (interquartile range [IQR]) APACHE II scores of 15 (19–18). Clinical success was observed in 68.8% of patients, with a mortality rate of 16.1% and comparable success rates across patients infected with carbapenem-resistant gram-negative infections. The most common isolated organisms were Pseudomonas aeruginosa (61/112, 54.5%, of which 55/61 were carbapenem-resistant) and carbapenem-resistant Acinetobacter baumannii (32/112, 28.6%). Median (IQR) time to CFDC therapy was 77 (14–141) hours. Two patients experienced a non-anaphylactic rash as an adverse drug reaction. On-treatment non-susceptibility to CFDC was found in six patients, notably due to P. aeruginosa and A. baumannii. IMPORTANCE CFDC was safe and clinically effective as a monotherapy or in combination in treating a variety of carbapenem-resistant gram-negative infections. Further prospective studies are warranted to confirm these findings.
Original language | English |
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Journal | Microbiology spectrum |
Volume | 12 |
Issue number | 2 |
DOIs | |
State | Published - Feb 2024 |
Bibliographical note
Publisher Copyright:Copyright © 2024 El Ghali et al.
Funding
A.E.G., A.J.K.C., K.L., M.T., S.L., G.I., A.P., D.J.H., and M.P.V. have no conflicts of interest to disclose. M.J.R. has received funds for research and consulting or participated in speaking bureaus for Abbvie, Ferring, Innoviva Specialty Therapeutics, Melinta, Merck, Paratek Pharmaceuticals, Shionogi, Tetraphase, and T2 Bioscience and is partially supported by National Institute of Allergy and Infectious Diseases R21 AI163726.
Funders | Funder number |
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National Institute of Allergy and Infectious Diseases | R21 AI163726 |
National Institute of Allergy and Infectious Diseases |
Keywords
- Acinetobacter baumannii
- Cefiderocol
- Pseudomonas aeruginosa
- carbapenem-resistant
- gram-negative resistance
ASJC Scopus subject areas
- Physiology
- Ecology
- General Immunology and Microbiology
- Genetics
- Microbiology (medical)
- Cell Biology
- Infectious Diseases