Bloodstream Infection Due to a VIM-Metallo-β-Lactamase-Producing Klebsiella pneumoniae Treated with Cefiderocol in a Preterm Newborn

Abstract

Background The prevalence of certain multidrug-resistant organisms (MDROs), especially Gram-negative bacteria, is dramatically increasing in patient care settings, including pediatric and neonatal units. However, most of the new drugs available for the treatment of MDROs have not yet been studied in children and newborns. Case report We report the clinical case of a preterm neonate, born at 31 weeks gestation + 1 day of age by emergency Cesarean Section (CS), with a bloodstream infection (BSI) due to a Verona integron-borne metallo-β-lactamase (VIM)-producing Klebsiella pneumoniae . We successfully treated the infection with cefiderocol in an off-label regimen at the following dose: loading dose 60 mg/kg and then 40 mg/kg every 8 h in extended infusion for 9 days. The baby showed a quick clinical and biochemical improvement and tolerated well the treatment. Follow-up blood cultures at 48 h after the start of cefiderocol were negative. Conclusions Antimicrobial-resistant pathogens are of increasing concern in neonatal settings. More studies in this unique population are necessary to better describe the pharmacokinetic and pharmacodynamic profile of the new drugs against MDROs, such as cefiderocol, and to define a proper effective dose.

New Antimicrobials for the Treatment of Neonatal Sepsis Caused by Multi-Drug-Resistant Bacteria: A Systematic Review

“…Instead, we decided to include studies on pharmacokinetic simulation models, although not enrolling patients in clinical settings, as they were considered useful for the validation of administration schedules in the age groups of interest. Finally, 50 articles [ 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , …”

Successful Use of Cefiderocol to Treat a Multidrug-resistant Stenotrophomonas maltophilia Ventilator-associated Pneumonia in an Extremely Preterm Neonate

“…No current clinical trials are enrolling neonates, despite the promise this antibiotic provides in light of its efficacy against MDR Gram-negative pathogens, as well as carbapenem-resistant A. baumannii complex infections-a frequent cause of VAP outbreaks in NICUs in resource-constrained settings. 10 Consequently, off-label antibiotic use in children-including for cefiderocol-is likely to increase, with reports of cefiderocol already being used to treat MDR P. aeruginosa, 32,33 Klebsiella pneumoniae [34][35][36] and Achromobacter xylosoxidans 37,38 in children and neonates.…”

Cefiderocol, a Siderophore Cephalosporin, as a Treatment Option for Infections Caused by Carbapenem-Resistant Enterobacterales

“…According to a recent case report of a 44-year-old male patient, who developed meningitis due to KPC-producing K. pneumoniae, 14-day treatment with cefiderocol plus trimethoprim-sulfamethoxazole resulted in eradication of K. pneumoniae from the cerebrospinal fluid and clinical success [152]. In a paediatric case report of BSI caused by VIMproducing K. pneumoniae, cefiderocol treatment resulted in clinical improvement and clearance of the blood isolate, although paediatric dosing for cefiderocol has yet to be established in clinical studies [153].…”