Related Experiment Video
Updated: Aug 17, 2025
Assessment of Intestinal Transcytosis of Neonatal Escherichia coli Bacteremia Isolates
Published on: February 17, 2023
Bloodstream Infection Due to a VIM-Metallo-β-Lactamase-Producing Klebsiella pneumoniae Treated with Cefiderocol in a
Caterina Monari1, Ferdinando Spagnuolo2, Mariantonietta Pisaturo1
1Department of Mental Health and Public Medicine - Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy.
Background:
The prevalence of certain multidrug-resistant organisms (MDROs), especially Gram-negative bacteria, is dramatically increasing in patient care settings, including pediatric and neonatal units. However, most of the new drugs available for the treatment of MDROs have not yet been studied in children and newborns.
Case Report:
We report the clinical case of a preterm neonate, born at 31 weeks gestation + 1 day of age by emergency Cesarean Section (CS), with a bloodstream infection (BSI) due to a Verona integron-borne metallo-β-lactamase (VIM)-producing Klebsiella pneumoniae. We successfully treated the infection with cefiderocol in an off-label regimen at the following dose: loading dose 60 mg/kg and then 40 mg/kg every 8 h in extended infusion for 9 days. The baby showed a quick clinical and biochemical improvement and tolerated well the treatment. Follow-up blood cultures at 48 h after the start of cefiderocol were negative.
Conclusions:
Antimicrobial-resistant pathogens are of increasing concern in neonatal settings. More studies in this unique population are necessary to better describe the pharmacokinetic and pharmacodynamic profile of the new drugs against MDROs, such as cefiderocol, and to define a proper effective dose.
Insights
This case study shows successful treatment of a preterm neonate with a multidrug-resistant Klebsiella pneumoniae bloodstream infection using cefiderocol. Further research is needed to establish optimal dosing for this vulnerable population.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pharmacology
Background:
- Increasing prevalence of multidrug-resistant organisms (MDROs), particularly Gram-negative bacteria, in healthcare settings.
- Limited data on the efficacy and safety of new antimicrobial agents in pediatric and neonatal populations.
Purpose of the Study:
- To report a successful off-label treatment of a neonatal bloodstream infection caused by a VIM-producing Klebsiella pneumoniae.
- To highlight the potential role of cefiderocol in treating challenging neonatal infections.
Main Methods:
- Case report of a preterm neonate (31 weeks gestation + 1 day) with bloodstream infection.
- Treatment with cefiderocol (60 mg/kg loading dose, then 40 mg/kg every 8 hours in extended infusion for 9 days).
- Clinical and biochemical monitoring, and follow-up blood cultures.
Main Results:
- Successful clinical and biochemical improvement in the neonate.
- Negative follow-up blood cultures at 48 hours after initiating cefiderocol.
- Good tolerability of the cefiderocol regimen.
Conclusions:
- Antimicrobial resistance is a significant threat in neonatal intensive care units.
- Further pharmacokinetic and pharmacodynamic studies of new drugs like cefiderocol are essential in neonates.
- Defining appropriate and effective dosing regimens for neonates is crucial.
Related Concept Videos
01:17Urinary Tract Infection IV: Nursing Management
01:29Endocarditis IV: Nursing Management
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:28Acute Pyelonephritis II: Diagnostic Studies and Management