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Published on: December 10, 2016
Real-world experience with cefiderocol in hematologic patients with malignancies
Ana Martinez-Urrea1, Laura Mezzogori2, Antonio Gallardo-Pizarro1
1Infectious Disease Department, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques Agust Pi i Sunyer (IDIBAPS), Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.
Objectives:
Given the limited real-world evidence in immunocompromised patients, we aimed to characterize cefiderocol use and outcomes in haematological patients.
Methods:
Retrospective, multicenter study including consecutive haematological malignancy patients treated with cefiderocol (July 2022-March 2025) at two tertiary-level hospitals in Spain and Italy.
Results:
Twenty-eight patients received cefiderocol; median age was 65.4 years, 50% male. Prior broad-spectrum antibiotics exposure occurred in 85.7% (24/28), and 57.1% (16/28) were colonized with multidrug-resistant (MDR) organisms. Cefiderocol was administered empirically in 53.5% (15/28) and as targeted therapy in 46.4% (13/28). Microbiological documentation obtained in 85.7% (24/28), with MDR pathogens in 75% (18/24). Pseudomonas aeruginosa was most frequent (13/28; 46.4%). Cefiderocol resistance occurred in 30.0% (3/10) of empirically gram-negative (GN) infections, and in 42.9% (3/7) of MDR-GNB cases, despite no prior exposure. One patient with necrotic skin P. aeruginosa infection developed resistance, with minimum inhibitory concentration increasing from 2 µg/mL to 64 µg/mL during follow-up. Two patients with MDR infections were clinically cured; however, new colonizations with cefiderocol-resistant P. aeruginosa and Verona integron-encoded metallo-β-lactamase (VIM)-producing Klebsiella pneumoniae developed during treatment. Overall, 30-day mortality was 35.7%.
Conclusions:
Cefiderocol showed clinical response and no safety signal were identified in hematologic malignancy patients with MDR infections. However, emerging resistance requires research to optimize its role.
