Introduction: Cefiderocol is a siderophore cephalosporin showing activity against various carbapenem-resistant Gram-negative bacteria (CR-GNB). No data currently exist about real-world use of cefiderocol in terms of types of therapy (e.g., empirical or targeted, monotherapy or combined regimens), indications, and patient characteristics. Methods: In this multicenter, prospective study, we aimed at describing the use of cefiderocol in terms of types of therapy, indications, and patient characteristics. Results: Cefiderocol was administered as empirical and targeted therapy in 27.5% (55/200) and 72.5% (145/200) of cases, respectively. Overall, it was administered as monotherapy in 101/200 cases (50.5%) and as part of a combined regimen for CR-GNB infections in the remaining 99/200 cases (49.5%). In multivariable analysis, previous isolation of carbapenem-resistant Acinetobacter baumannii odds ratio (OR) 2.56, with 95% confidence interval (95% CI) 1.01-6.46, p = 0.047] and previous hematopoietic stem cell transplantation (OR 8.73, 95% CI 1.05-72.54, p = 0.045) were associated with administration of cefiderocol as part of a combined regimen, whereas chronic kidney disease was associated with cefiderocol monotherapy (OR 0.38 for combined regimen, 95% CI 0.16-0.91, p = 0.029). Cumulative 30-day mortality was 19.8%, 45.0%, 20.7%, and 22.7% in patients receiving targeted cefiderocol for infections by Enterobacterales, A. baumannii, Pseudomonas aeruginosa, and any metallo-β-lactamase producers, respectively. Conclusions: Cefiderocol is mainly used for targeted treatment, although empirical therapies account for more than 25% of prescriptions, thus requiring dedicated standardization and guidance. The almost equal distribution of cefiderocol monotherapy and cefiderocol-based combination therapies underlines the need for further study to ascertain possible differences in efficacy between the two approaches.
Use of Cefiderocol in Adult Patients: Descriptive Analysis from a Prospective, Multicenter, Cohort Study / 1 2, Daniele Roberto Giacobbe; 3, Laura Labate; 3 4, Chiara Russo Artimagnella; 4, Cristina Marelli; 5, Alessio Signori; 6, Vincenzo Di Pilato; 7, Chiara Aldieri; 8 9, Alessandra Bandera; Briano 10, Federica; Cacopardo 11, Bruno; Calabresi 12, Alessandra; Capra Marzani 13, Federico; Carretta 14, Anna; Cattelan 15, Annamaria; Ceccarelli 16 17, Luca; Cenderello 18, Giovanni; Corcione 19 20, Silvia; Cortegiani 21 22, Andrea; Cultrera 23 24, Rosario; Giuseppe De Rosa 19, Francesco; 7, Valerio Del Bono; Del Puente 25, Filippo; Fanelli 26, Chiara; Fava 27, Fiorenza; Francisci 28, Daniela; Geremia 29 30, Nicholas; Graziani 31, Lucia; 8 9, Andrea Lombardi; Raffaella Losito 32, Angela; Maida, Ivana; Marino 11, Andrea; Mazzitelli 15, Maria; Merli 33, Marco; Monardo 34 35, Roberta; Mularoni 36, Alessandra; Oltolini 33, Chiara; Pallotto 28, Carlo; Pontali 25, Emanuele; Raffaelli 32, Francesca; Rinaldi 16 17, Matteo; Ripa 34 35, Marco; Antonia Santantonio 14, Teresa; Saverio Serino 37, Francesco; Spinicci 31 38, Michele; Torti 32 39, Carlo; Maria Trecarichi 40 41, Enrico; Tumbarello 42 43, Mario; 3 4, Malgorzata Mikulska; Giacomini 44, Mauro; 6 45, Anna Marchese; 3 4, Antonio Vena; Bassetti, Matteo. - In: INFECTIOUS DISEASES AND THERAPY. - ISSN 2193-6382. - (2024). [10.1007/s40121-024-01016-y]
Use of Cefiderocol in Adult Patients: Descriptive Analysis from a Prospective, Multicenter, Cohort Study
Ivana Maida
;
2024-01-01
Abstract
Introduction: Cefiderocol is a siderophore cephalosporin showing activity against various carbapenem-resistant Gram-negative bacteria (CR-GNB). No data currently exist about real-world use of cefiderocol in terms of types of therapy (e.g., empirical or targeted, monotherapy or combined regimens), indications, and patient characteristics. Methods: In this multicenter, prospective study, we aimed at describing the use of cefiderocol in terms of types of therapy, indications, and patient characteristics. Results: Cefiderocol was administered as empirical and targeted therapy in 27.5% (55/200) and 72.5% (145/200) of cases, respectively. Overall, it was administered as monotherapy in 101/200 cases (50.5%) and as part of a combined regimen for CR-GNB infections in the remaining 99/200 cases (49.5%). In multivariable analysis, previous isolation of carbapenem-resistant Acinetobacter baumannii odds ratio (OR) 2.56, with 95% confidence interval (95% CI) 1.01-6.46, p = 0.047] and previous hematopoietic stem cell transplantation (OR 8.73, 95% CI 1.05-72.54, p = 0.045) were associated with administration of cefiderocol as part of a combined regimen, whereas chronic kidney disease was associated with cefiderocol monotherapy (OR 0.38 for combined regimen, 95% CI 0.16-0.91, p = 0.029). Cumulative 30-day mortality was 19.8%, 45.0%, 20.7%, and 22.7% in patients receiving targeted cefiderocol for infections by Enterobacterales, A. baumannii, Pseudomonas aeruginosa, and any metallo-β-lactamase producers, respectively. Conclusions: Cefiderocol is mainly used for targeted treatment, although empirical therapies account for more than 25% of prescriptions, thus requiring dedicated standardization and guidance. The almost equal distribution of cefiderocol monotherapy and cefiderocol-based combination therapies underlines the need for further study to ascertain possible differences in efficacy between the two approaches.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
