Cefiderocol Red Wine Urine Syndrome in Pediatric Patients: A Multicenter Case Series

Area of Science:

• Infectious Diseases
• Pharmacology
• Pediatrics

Background:

• Cefiderocol is a novel cephalosporin antibiotic effective against multidrug-resistant Gram-negative bacteria.
• Pediatric experience with cefiderocol is limited.
• Blood transfusions are common in immunocompromised pediatric patients.

Purpose of the Study:

• To describe a case series of pediatric patients experiencing a specific side effect with cefiderocol.
• To investigate a potential interaction between cefiderocol and blood products.
• To raise awareness of a benign urinary discoloration phenomenon in children.

Main Methods:

• Case series describing 3 immunocompromised children.
• Observation of urinary color changes during cefiderocol administration.
• Review of potential mechanisms for the observed side effect.

Main Results:

• Three immunocompromised children receiving blood transfusions developed benign red or purple urine during cefiderocol treatment.
• The urinary discoloration was transient and not associated with adverse events.
• A potential interaction between cefiderocol and iron from blood products was hypothesized.

Conclusions:

• Cefiderocol can cause benign red or purple urine in pediatric patients, particularly those receiving blood transfusions.
• This phenomenon is likely due to an interaction with iron in blood products.
• Clinicians should be aware of this side effect to avoid misdiagnosis of hematuria and unnecessary investigations.