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The Use of Cefiderocol as Salvage Therapy in an Infant Receiving ECMO and Continuous Renal Replacement Therapy
Stefania Mercadante1, Costanza Tripiciano1, Lorenza Romani1
1Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Insights
Antimicrobial-resistant Pseudomonas aeruginosa infections are a growing concern. Cefiderocol shows promise as a salvage therapy for critically ill pediatric patients with difficult-to-treat infections.
Area of Science:
- Infectious Diseases
- Pharmacology
- Critical Care Medicine
Background:
- Rising global antimicrobial resistance (AMR) poses significant public health challenges.
- Pseudomonas aeruginosa (PA) infections are increasingly difficult to treat due to widespread antibiotic resistance, particularly in intensive care units (ICUs).
- Cefiderocol, an injectable siderophore cephalosporin, is a limited therapeutic option for extensively drug-resistant (XDR)-PA and difficult-to-treat resistance (DTR)-PA, with restricted use in pediatric populations.
Observation:
- A critically ill 8-month-old girl developed ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) caused by VIM-producing PA.
- The patient required extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) support.
- Cefiderocol was administered as a salvage therapy under these critical care conditions.
Findings:
- This case report details the successful use of cefiderocol in a pediatric patient with a complex, multidrug-resistant Gram-negative bacterial infection.
- The treatment was administered as a rescue therapy during ECMO and CRRT, highlighting its potential in life-threatening situations.
- The patient's outcome suggests cefiderocol's efficacy in managing severe PA infections unresponsive to other treatments.
Implications:
- Treating multidrug-resistant Gram-negative bacteria in pediatric patients presents substantial clinical challenges.
- Cefiderocol may be considered a viable off-label rescue therapy for select pediatric cases involving difficult-to-treat Gram-negative infections.
- Further investigation into cefiderocol's safety and efficacy in pediatric populations is warranted.
Background:
Infections caused by antimicrobial-resistant (AMR) pathogens are increasing worldwide, representing a serious global public health issue with high morbidity and mortality rates The treatment of Pseudomonas aeruginosa (PA) infections has become a significant challenge due to its ability to develop resistance to many of the currently available antibiotics, especially in intensive care unit (ICU) settings. Among the very few therapeutic lines available against extensively drug-resistant (XDR)-PA and/or with difficult-to-treat resistance (DTR)-PA, cefiderocol is an injectable siderophore cephalosporin not licensed for use in pediatric patients. There are only a few case reports and two ongoing trials describing the administration of this cephalosporin in infants.
Case Presentation:
This report describes the case of a critically ill 8-month-old girl affected by ventilator-associated pneumonia (VAP) infection complicated by bloodstream infection (BSI) sustained by VIM-producing PA. She was treated with cefiderocol as a salvage therapy during ECMO and CRRT support.
Conclusions:
In healthcare settings, treating multidrug-resistant, Gram-negative bacteria poses a serious challenge, especially in pediatric patients. Our findings suggest that cefiderocol can be considered as an off-label rescue therapy in selected pediatric cases.
