Real-life impact of cefiderocol in carbapenem-resistant Acinetobacter baumannii infections (CRAb): a narrative review

Healthcare-associated infections (HAIs) represent one of the most serious complications in medical care, with a substantial global burden. The emergence and spread of antibiotic resistance, particularly among multidrug-resistant organisms such as carbapenem-resistant Acinetobacter baumannii (CRAb), have significantly complicated infection management.

The aim of this review is to provide an updated perspective on its clinical use and to explore novel therapeutic strategies for combating multidrug-resistant bacterial infections.

A narrative review was performed in accordance with PRISMA 2020 guidelines, including real-world, comparative, and longitudinal observational studies that assessed cefiderocol efficacy, safety, and associated clinical outcomes.

The findings suggest that cefiderocol is a promising therapeutic agent for CRAb infections, demonstrating lower mortality rates compared to colistin-based regimens. Comparative studies also report a superior safety profile, particularly regarding reduced nephrotoxicity. Cefiderocol unique siderophore-mediated mechanism facilitates efficient bacterial uptake, enabling activity even against carbapenem-resistant strains.

Although emerging evidence supports cefiderocol efficacy and safety, concerns persist about the potential for resistance development. Further randomized controlled trials are needed to clarify its role in the daily clinical practice and establish definitive treatment guidelines. In this context, the inclusion of reference intervals for resistance emergence during therapy is recommended, underscoring the need for vigilant monitoring throughout treatment.