Clinical Outcome of Cefiderocol for Infections with Carbapenem-Resistant Organisms

Area of Science:

• Infectious Diseases
• Pharmacology
• Critical Care Medicine

Background:

• Cefiderocol is a novel cephalosporin antibiotic approved for treating multidrug-resistant gram-negative organisms, including carbapenem-resistant strains.
• The emergence of antimicrobial resistance necessitates evaluating new therapeutic options like cefiderocol.

Purpose of the Study:

• To evaluate the 14- and 28-day all-cause mortality rates associated with cefiderocol treatment.
• To compare mortality outcomes between cefiderocol monotherapy and combination therapy.

Main Methods:

• Retrospective chart review of adult patients receiving cefiderocol for at least 3 days at Stony Brook University Hospital (October 2020 - December 2021).
• Exclusion criteria included multiple cefiderocol courses or ongoing hospitalization.
• Analysis of 28-day mortality based on infection type (BSI, cUTI, LRTI) and treatment regimen (monotherapy vs. dual therapy).

Main Results:

• Overall 28-day all-cause mortality was 13.6% in 22 eligible patients.
• Mortality rates were 0% for bloodstream infections (BSI) and complicated urinary tract infections (cUTI), and 16.7% for lower respiratory tract infections (LRTI).
• Patients receiving dual antibiotics with cefiderocol had 0% mortality compared to 25% for monotherapy (p=0.25); treatment failure occurred in 9.1%.

Conclusions:

• Cefiderocol may be associated with lower all-cause mortality than previously suggested.
• No significant difference in outcomes was observed between cefiderocol monotherapy and combination therapy in this cohort.
• Further research with larger sample sizes is warranted to confirm these findings.