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

Ava Diarra1,2, Maxime Degrendel3, Isabelle Eberl4

  • 1Department of Infectious Diseases, Hôpital Gustave Dron, 59200 Tourcoing, France.

Antibiotics (Basel, Switzerland)
|April 29, 2025
PubMed

Insights

Cefiderocol shows potential for treating multidrug-resistant Gram-negative bacilli bone and joint infections, though outcomes varied. Further research is needed to confirm its efficacy and safety in this patient population.

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.
Keywords:
Gram-negative bacillibone and joint infectioncefiderocoloutcometolerance

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