Real-Life Cefiderocol Use in Bone and Joint Infection: A French National Cohort

Area of Science:

• Infectious Diseases
• Pharmacology
• Orthopedics

Background:

• Cefiderocol (CFD) is a novel siderophore cephalosporin designed for multidrug-resistant Gram-negative bacilli (MDR-GNB) infections.
• Its use in bone and joint infections (BJIs) is not currently approved or widely studied, creating a data gap.
• This study addresses the need for data on CFD's application in BJIs.

Purpose of the Study:

• To describe patient and infection characteristics in BJIs treated with CFD.
• To evaluate the outcomes of CFD treatment for BJIs.
• To assess the safety and efficacy of cefiderocol in a real-world setting for BJIs.

Main Methods:

• Retrospective, observational, multicenter study conducted across 22 French centers.
• Data collected from January 2019 to December 2023.
• Inclusion of 45 patients with BJIs treated with cefiderocol.

Main Results:

• The study included 45 patients, predominantly males (73%), with a median age of 62.
• Implant-related infections were common (44%), often involving carbapenemase-producing GNB (74%), including Pseudomonas aeruginosa.
• CFD was administered at 6g/day, often in combination therapy (89%), with a median treatment duration of 34 days. Side effects were observed in 16% of patients. Infection control involved surgery in 82% of cases, with high rates of failure (49%) and mortality (22%).

Conclusions:

• Cefiderocol may serve as a viable therapeutic option for BJIs caused by MDR-GNB, especially when other treatments are limited.
• The study highlights the need for further investigation into optimal dosing and combination strategies.
• Clinical outcomes suggest a need for careful patient selection and monitoring when using CFD for BJIs.