Cefiderocol Efficacy in a Real-Life Setting: Single-Centre Retrospective Study.

Area of Science:

• Infectious Diseases
• Antimicrobial Resistance
• Clinical Pharmacology

Background:

• Current guidelines offer limited evidence on cefiderocol (CFD) efficacy against carbapenem-resistant gram-negative bacteria (CR-GN), particularly carbapenem-resistant Acinetobacter baumannii (CRAB).
• Real-world data is crucial for understanding CFD's clinical utility in treating challenging CR-GN infections.

Purpose of the Study:

• To evaluate the real-world effectiveness of cefiderocol (CFD) in patients with CR-GN infections.
• To identify factors associated with mortality and clinical outcomes in patients treated with CFD.

Main Methods:

• A single-center retrospective study included 41 patients with various CR-GN infections treated with CFD.
• Data collected included infection types, treatment regimens (monotherapy vs. combination), clinical cure rates, microbiological eradication, and 30-day mortality.
• Univariate and multivariate analyses were performed to identify predictors of mortality.

Main Results:

• Carbapenem-resistant Acinetobacter baumannii (CRAB) was the most common pathogen (75.6%).
• The 30-day all-cause mortality rate was 36.6%, with 56.1% achieving clinical cure and microbiological eradication at end-of-treatment.
• Septic shock was identified as an independent factor associated with mortality.
• Subgroup analyses revealed no significant difference in CFD effectiveness between monotherapy and combination therapy.

Conclusions:

• Cefiderocol demonstrates moderate clinical effectiveness in a real-world setting for CR-GN infections, including CRAB.
• Septic shock is a significant predictor of mortality in this patient population.
• CFD appears effective regardless of whether it is used as monotherapy or in combination with other agents.