Case Report: Successful Rescue Therapy of Extensively Drug-Resistant Acinetobacter baumannii Osteomyelitis With Cefiderocol

Abstract

Cefiderocol is a novel catechol siderophore cephalosporin antibiotic developed to treat resistant gram-negative infections. We describe its successful use as rescue therapy, combined with surgical debridement, to treat a patient with osteomyelitis due to extensively drug-resistant Acinetobacter baumannii. Bacterial whole-genome sequencing identified the strain and antibiotic resistance determinants.

Carbapenem resistance in Acinetobacter baumannii , and their importance in hospital‐acquired infections: a scientific review

“…It is stable against b-lactamases hydrolysis and has shown in vitro efficacy against Gram-negative bacteria such as A. baumannii. For example, a patient with osteomyelitis caused by extreme drug resistant (XDR) A. baumannii was successfully treated with surgical debridement and cefiderocol (Dagher et al 2020). Although there were additional reports demonstrating the safe and efficient use of cefiderocol to treat serious infections caused by this bacteria, more pharmacokinetic studies need to be investigated in order to understand the link between cefiderocol and its bactericidal activity (Hsueh et al 2019).…”

Cefiderocol: A Novel Siderophore Cephalosporin against Multidrug‐Resistant Gram‐Negative Pathogens

“…Additionally, in these cases, CFDC was initiated as a last‐resort treatment, and in combination with other Gram‐negative active agents. Nonetheless, in each of these cases, the patient’s infections resolved after the initiation of CFDC 70–74 …”

“…Nonetheless, in each of these cases, the patient's infections resolved after the initiation of CFDC. [70][71][72][73][74]…”

Evaluating Cefiderocol in the Treatment of Multidrug-Resistant Gram-Negative Bacilli: A Review of the Emerging Data

“… Patient 1: early postoperative, polymicrobial, implant-associated wound infection due to VIM-producing P. aeruginosa , OXA-23-producing A. baumannii , and KPC-producing Enterobacter cloacae Patient 2: postoperative implant-associated spine infection due to OXA-40 and NDM- producing A. baumannii Patient 3: pleural empyema due to XDR A. baumannii and subsequent acute osteomyelitis and urinary tract infection due to XDR A. baumannii . Patient 1: Treatment: multiple surgeries plus cefiderocol for 2 weeks and colistin and ceftazidime-avibactam for 4 weeks Patient 2: Treatment: removal of osteosynthesis and colistin plus cefiderocol for 14 days, then cefiderocol monotherapy for a total of 6 weeks Patient 3: Treatment: cefiderocol plus colistin (for 14 days) for pleural empyema and cefiderocol (6 weeks) for osteomyelitis Patient 1: Definite implantation and not signs of relapse at 8 weeks of follow-up Patient 2: Novel osteosynthesis with no signs of relapse at 13 weeks of follow-up Patient 3: No signs of relapse at 6 weeks of follow-up 57, male 66 Hypertension, diabetes mellitus, left tibia and fibula fracture with external fixation followed by two surgical debridements. Osteomyelitis of left leg with intraoperative cultures positive for Enterococcus faecalis, Corynebacterium striatum , And XDR A. baumannii .…”

“…Case reports and case series of patients with severe GNB infections treated with cefiderocol in compassionate use are detailed in Table 3. [54][55][56][57][58][59][60][61][62][63][64][65][66] All these cases highlight unique challenges in managing patients infected by MDR-GNB including MBL-producing GNB.…”