Real-Life Data on the Effectiveness and Safety of Cefiderocol in Severely Infected Patients: A Case Series

Abstract

Introduction Real-life data about cefiderocol use to treat extensively drug-resistant bacteria are scarce. We aim to report our early experience in patients with difficult-to-treat infections and limited therapeutic options. Methods Patients treated with cefiderocol from March 2018 to April 2022 in a tertiary-care hospital in Spain were included. Demographic, clinical, and microbiological data were collected up to 90 days after the end of treatment or until death. Survival status was recorded at 30 and 90 days. Results Ten patients were included, seven of them critically ill. Ventilator-associated pneumonia (40%) and bacteremia (40%) were the main infections. Multidrug-resistant or extensively drug-resistant P. aeruginosa was the most frequently isolated pathogen (70%, of which six patients were infected with bacteria with difficult-to-treat resistance), followed by A. baumannii , E. coli , and A. xylosoxidans (10% each). Seven patients received combination therapy. Clinical and microbiological cures were achieved in 90% and 80% of patients, respectively. Two previously susceptible strains (20%) developed resistance to cefiderocol. Overall, 30-day and 90-day mortality rates were 10% and 50%, respectively, although two out of five patients died due to the infection. No serious adverse events were reported, except for one patient who developed thrombocytopenia. Conclusion Cefiderocol seems to be an effective and safe rescue therapy for patients infected with difficult-to-treat pathogens, although there is a definite risk of the emergence of resistance.

Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidence

“…In a recent report, one patient without comorbid conditions, who developed VAP and sepsis, received ECMO and was infected by XDR/DTR A. baumannii, New Delhi metallo-beta-lactamase (NDM)-producing K. pneumoniae, and Candida auris. Following cefiderocol treatment with dose adjustment, clinical cure, microbiological cure was reported for the patient with survival at day 30 [112].…”

Cefiderocol: early clinical experience for multi-drug resistant gram-negative infections

“…Although several papers have documented the real-world outcomes of CFDC, the majority of these are single-center studies with fewer than 50 total patients or pathogen-specific groups ( 33 , 39 ). Moreover, many of these studies lack number and diversity of carbapenem-resistant organisms , which is a strength of our study ( 33 , 36 , 39 , 40 ). The most extensive study to date was a recently published retrospective cohort consisting of 48 patients from the VA medical system.…”

Antimicrobial and Diagnostic Stewardship of the Novel β-Lactam/β-Lactamase Inhibitors for Infections Due to Carbapenem-Resistant Enterobacterales Species and Pseudomonas aeruginosa

“…In addition, cefiderocol, a siderophore cephalosporin resistant to most β-lactamases, including carbapenemases, is increasingly being used for the treatment of multidrug-resistant Gram-negative infections, including carbapenem-resistant Enterobacterales and P. aeruginosa [ 132 ]. Although clinical experience with this agent is limited, it has shown promise as a last-line therapy against numerous carbapenem-resistant isolates, including carbapenem-resistant P. aerugionsa and A. baumanni [ 17 , 133 ]. The versatility of streamlined algorithmic processes allows for treatment flexibility based on newer guidelines.…”