Compassionate use of cefiderocol in a pancreatic abscess and emergence of resistance

Perez, Carolina Grande; Maillart, Evelyne; Deyi, Véronique Yvette Miendje; Huang, Te Din; Kamgang, Prochore; Dernier, Y.; Clevenbergh, Philippe

doi:10.1016/j.medmal.2020.10.022

Cited by 15 publications

(21 citation statements)

References 9 publications

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“…Grande et al have reported that a 63-year-old male patient with septic shock is presented at the intensive care unit (ICU) due to the initial infection of ESBL K. pneumoniae , oxacillin-sensitive Staphylococcus aureus , and multi-sensitive P. aeruginosa . Then, a VIM-producing XDR P. aeruginosa grows from his sputum on day 26 ( 36 ). On day 54, the regimen of colistin and meropenem is switched to CFDC 2 g q8h infused over 3 h plus metronidazole 500 mg TID as P. aeruginosa is susceptible to CFDC.…”

Section: Reports Of In-vivo Resistance To Cfdcmentioning

confidence: 99%

“…On day 54, the regimen of colistin and meropenem is switched to CFDC 2 g q8h infused over 3 h plus metronidazole 500 mg TID as P. aeruginosa is susceptible to CFDC. The treatment regimen is discontinued after 6 weeks ( 36 ). On day 128, GES- and VIM-producing XDR P. aeruginosa are isolated from ischial eschar with an MIC90 value of CFDC increased to 8 mg/l ( 36 ).…”

Section: Reports Of In-vivo Resistance To Cfdcmentioning

confidence: 99%

“…The treatment regimen is discontinued after 6 weeks ( 36 ). On day 128, GES- and VIM-producing XDR P. aeruginosa are isolated from ischial eschar with an MIC90 value of CFDC increased to 8 mg/l ( 36 ). It indicates that P. aeruginosa develops resistance during CFDC treatment.…”

Section: Reports Of In-vivo Resistance To Cfdcmentioning

confidence: 99%

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Cefiderocol: An Overview of Its in-vitro and in-vivo Activity and Underlying Resistant Mechanisms

Yao¹,

Wang²,

Chen³

et al. 2021

Front. Med.

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Treatment of multidrug-resistant (MDR) Gram-negative bacteria (GNB) infections has led to a global public health challenging due to the bacterial resistance and limited choices of antibiotics. Cefiderocol (CFDC), a novel siderophore cephalosporin possessed unique drug delivery systems and stability to β-lactamases, has the potential to become first-line therapy for most aggressive MDR Gram-negative pathogens infection. However, there have been reports of drug resistance in the course of using CFDC. This study provides an overview of the in-vitro and in-vivo activity of CFDC and potential resistance mechanism was also summarized. In general, CFDC shows excellent activity against a broad range of MDR GNB pathogens including Enterobacteriaceae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia. The expressions of metallo-β-lactamases such as inosine 5'-monophosphate (IMP), Verona integron-mediated metallo-β-lactamase (VIM), and New Delhi metallo-β-lactamase (NDM) are associated with a higher resistance rate of CFDC. Carbapenem-resistant phenotype has little effect on the resistance rate, although the acquisition of a particular carbapenemase may affect the susceptibility of the pathogens to CFDC. For potential resistance mechanism, mutations in β-lactamases and TonB-dependent receptors, which assist CFDC entering bacteria, would increase a minimum inhibitory concentration (MIC)90 value of CFDC against MDR pathogens. Since the development of CFDC, resistance during its utilization has been reported thus, prudent clinical applications are still necessary to preserve the activity of CFDC.

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Section: Reports Of In-vivo Resistance To Cfdcmentioning

confidence: 99%

Section: Reports Of In-vivo Resistance To Cfdcmentioning

confidence: 99%

See 1 more Smart Citation

Cefiderocol: An Overview of Its in-vitro and in-vivo Activity and Underlying Resistant Mechanisms

Yao¹,

Wang²,

Chen³

et al. 2021

Front. Med.

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show abstract

“… First line empiric: piperacillin-tazobactam, clindamycin, and amikacin, in addition to surgical debridement Second line: colistin, tigecycline Third line: cefiderocol plus colistin, then de-escalated to cefiderocol monotherapy. Treated with cefiderocol for 14 days Improvement and discharge from ICU, subsequent death in a medical ward without signs of infection relapse 63, male 60 Obesity, diabetes mellitus, cardiac ischemic disease, gout arthritis. Para-duodenal pancreatic collection with extensively drug resistant (XDR) P. aeruginosa (susceptible to colistin and cefiderocol) isolated from pancreatic pus.…”

Section: Case Reports and Case Seriesmentioning

confidence: 99%

“…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.…”

Section: Case Reports and Case Seriesmentioning

confidence: 99%

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

Giacobbe¹,

Ciacco²,

Girmenia³

et al. 2020

IDR

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Safety and efficacy of cefiderocol for off‐label treatment indications: A systematic review

et al. 2022

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Purpose Cefiderocol is a siderophore cephalosporin recently approved by the United States Food and Drug Administration for the treatment of hospital‐ and ventilator‐acquired bacterial pneumonia and complicated urinary tract infections. However, there is potential for cefiderocol utility for a variety of other infections. The purpose of this systematic review was to identify literature examining the safety and efficacy of cefiderocol for off‐label indications. Methods The PRISMA guidelines were utilized for reporting. Databases searched included PubMed, Scopus, and Embase, from inception to September 2021. Manuscripts describing cefiderocol off‐label use in clinical settings were included. Exclusion criteria were studies focused on labeled indications, animal studies, pharmacodynamic/pharmacokinetic studies, in vitro or laboratory studies, and manuscripts in languages other than English or Arabic. Each stage of review utilized two independent investigators, with conflicts resolved and critical appraisal performed. Data regarding presentation, clinical course, and infection characteristics were extracted and descriptively analyzed. Results The search identified a total of 985 records, narrowed to a final set of 27 studies. Among studies included were 18 (66.7%) case reports, 8 (29.6%) case series, and 1 (3.7%) phase 3 clinical trial. Cefiderocol was most frequently used off‐label for bacteremia/sepsis with or without an identified source in 51 (67.1%) out of a total of 76 included patients. Among case series/reports with available data, 43 of 53 patients (81.1%) received combination antibiotic therapy. The most common pathogens identified included multi/extensively drug‐resistant Pseudomonas aeruginosa and/or Acinetobacter baumannii. Various clinical end points were reported, while microbiological end points were reported in 18 (66.7%) studies. Cefiderocol‐related side effects were uncommon and rarely use‐limiting. Conclusions This systematic review depicts relative clinical effectiveness of off‐label cefiderocol, most commonly for P. aeruginosa and A. baumannii infections as combination antibiotic therapy. Further study is needed to elucidate the safety and efficacy of cefiderocol across an expanded set of patients and indications.

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Compassionate use of cefiderocol in a pancreatic abscess and emergence of resistance

Cited by 15 publications

References 9 publications

Cefiderocol: An Overview of Its in-vitro and in-vivo Activity and Underlying Resistant Mechanisms

Cefiderocol: An Overview of Its in-vitro and in-vivo Activity and Underlying Resistant Mechanisms

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

Safety and efficacy of cefiderocol for off‐label treatment indications: A systematic review

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