Cefiderocol use in Gram negative infections with limited therapeutic options: Is combination therapy the key?. Issue 9 (September 2022)

• Record Type: Journal Article
• Authors: Corcione, Silvia; De Benedetto, Ilaria; Pinna, Simone Mornese; Vita, Davide; Lupia, Tommaso; Montrucchio, Giorgia; Brazzi, Luca; De Rosa, Francesco Giuseppe
• Is Part Of: Journal of infection and public health. Volume 15:Issue 9(2022)
• Page Start: 975
• Page End: 979
• Publication Date: 2022-09
• Subjects: Cefiderocol -- Gram negative bacteria -- Acinetobacter baumannii -- VAP -- Combination therapy; Communicable diseases -- Periodicals; Public health -- Periodicals; Epidemiology -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Medical microbiology -- Periodicals; 614.4
• DOI: 10.1016/j.jiph.2022.07.006
• Languages: English
• ISSNs: 1876-0341

Abstract

Abstract: Objectives: To date limited information about cefiderocol use is provided by real life studies. Our aim is to evaluate characteristics and outcome of patients with Gram-negative infections with limited therapeutic options treated with cefiderocol in combination or monotherapy. Methods: We retrospectively collected data on demographical, clinical characteristics and clinical cure, in-hospital and 30-days mortality, microbiological failure and Clostridioides difficile infections of all patients ≥ 18 years old treated with cefiderocol for ≥ 48 h. Results: There were 18 patients of which 14 (77.8%) treated with cefiderocol in combination and 4 (22.2%) with monotherapy. Median age was 54.5 (IQR 35.25–65.75) vs 70.5 (IQR 57.5–78.25) years old, respectively and ward of admission was the ICU in the 78.57% vs 100% of cases. In the 50% vs 100% of cases infections were VAP with concomitant bloodstream infections. Median SOFA score was 10 (IQR 4.5–12.5) vs 5 (IQR 4–6) and APACHE II score was 13.5 (IQR 7.5–18) vs 16 (IQR 8.5–23.5), respectively. Isolated pathogen was carbapenems-resistant Acinetobacter baumannii in 78.57% vs 100% of cases. Median duration of cefiderocol treatment was 9.5 (IQR 7–13.25) vs 9 days (IQR 5.5–12.5) and in 77.8% patients it was used in combination therapy, of which 57.1% were colistin-spairing regimens. Clinical cure was achieved in 64.29% for combination therapy vs 75% of monotherapy treated patients, 30-days mortality rate was 28.57% vs 25% and 30-day ICU admission rate was 14.29% vs 50%, respectively. No statistically significant differences were observed between combination therapy and monotherapy treated patients. Conclusions: To date, no differences have been demonstrated between cefiderocol monotherapy or combination. Further studies are required to understand whether cefiderocol combination therapy could provide an advantage in outcome in seriously-ill patients. Highlights: Eighteen patients have been treated with cefiderocol monotherapy or combination. In most cases, cefiderocol combination therapy was a colistin-sparing regimen. Acinetobacter baumannii VAP and bloodstream-infections were most frequent. Overall clinical cure was achieved in 66.7% of patients. 30-days mortality was 27.8% with no differences between monotherapy or combination.