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Effective cefiderocol CSF penetration for treating Stenotrophomonas maltophilia ventriculitis
Clara Ribera1, Ariadna Padullés1,2,3, Fe Tubau4,5
1Pharmacy Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Background:
Bacterial ventriculitis associated with CSF shunts or drains is a life-threatening infection often caused by MDR pathogens such as Stenotrophomonas maltophilia. Cefiderocol, an IV siderophore cephalosporin approved for drug-resistant Gram-negative infections, lacks extensive clinical data supporting its use in CNS infections.
Objectives:
We describe a case of S. maltophilia ventriculitis successfully treated with cefiderocol monotherapy at a standard dose of 2 g IV every 8 h. Data on cefiderocol CSF drug penetration are reported.
Methods:
Cefiderocol trough plasma and CSF concentrations (C min) were determined at steady-state conditions, and S. maltophilia susceptibility testing was determined using Etest and disc diffusion.
Results:
Therapeutic drug monitoring showed sustained CSF cefiderocol concentrations. CSF cefiderocol C min remained 116.0- and 131.8-fold above the isolate's MIC throughout the dosing interval, with plasma-to-CSF penetration ratios of 16.6%-25.7%. Patient's clinical cure was achieved after 26 days of therapy without adverse events or relapse at 1 year of follow-up.
Conclusions:
Our data show that cefiderocol at a standard dose of 2 g IV every 8 h achieved sustained therapeutic concentrations in the CSF. Cefiderocol monotherapy may be an option for CNS infections with MDR Gram-negative bacteria with low MICs such as S. maltophilia.
Insights
Cefiderocol effectively treated Stenotrophomonas maltophilia ventriculitis, achieving therapeutic drug concentrations in cerebrospinal fluid (CSF). This suggests cefiderocol monotherapy may be a viable option for central nervous system infections caused by drug-resistant Gram-negative bacteria.
Area of Science:
- Infectious Diseases
- Pharmacology
- Neuroscience
Background:
- Bacterial ventriculitis, often caused by multidrug-resistant (MDR) pathogens like Stenotrophomonas maltophilia, is a severe infection linked to CSF shunts.
- Cefiderocol, an intravenous siderophore cephalosporin, is approved for resistant Gram-negative infections but has limited clinical data in central nervous system (CNS) infections.
Purpose of the Study:
- To report a case of S. maltophilia ventriculitis successfully treated with cefiderocol monotherapy.
- To evaluate cefiderocol's penetration into the cerebrospinal fluid (CSF) and its efficacy in treating CNS infections.
Main Methods:
- A patient with S. maltophilia ventriculitis received cefiderocol monotherapy at a standard dose (2g IV every 8h).
- Cerebrospinal fluid (CSF) and plasma cefiderocol concentrations were measured at steady-state.
- Susceptibility testing for S. maltophilia was performed using Etest and disc diffusion.
Main Results:
- Therapeutic drug monitoring confirmed sustained cefiderocol concentrations in CSF, exceeding the isolate's minimum inhibitory concentration (MIC) by 116.0- to 131.8-fold.
- Plasma-to-CSF penetration ratios ranged from 16.6% to 25.7%.
- The patient achieved clinical cure after 26 days of therapy, with no adverse events or relapse at one-year follow-up.
Conclusions:
- Standard-dose cefiderocol (2g IV every 8h) achieves sustained therapeutic concentrations in the CSF.
- Cefiderocol monotherapy presents a potential treatment option for CNS infections caused by MDR Gram-negative bacteria, such as S. maltophilia, with low MICs.
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