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Giacobbe DR, Labate L, Russo Artimagnella C, Marelli C, Signori A, Di Pilato V, Aldieri C, Bandera A, Briano F, Cacopardo B, Calabresi A, Capra Marzani F, Carretta A, Cattelan A, Ceccarelli L, Cenderello G, Corcione S, Cortegiani A, Cultrera R, De Rosa FG, Del Bono V, Del Puente F, Fanelli C, Fava F, Francisci D, Geremia N, Graziani L, Lombardi A, Losito AR, Maida I, Marino A, Mazzitelli M, Merli M, Monardo R, Mularoni A, Oltolini C, Pallotto C, Pontali E, Raffaelli F, Rinaldi M, Ripa M, Santantonio TA, Serino FS, Spinicci M, Torti C, Trecarichi EM, Tumbarello M, Mikulska M, Giacomini M, Marchese A, Vena A, Bassetti M. Use of Cefiderocol in Adult Patients: Descriptive Analysis from a Prospective, Multicenter, Cohort Study. Infect Dis Ther 2024:10.1007/s40121-024-01016-y. [PMID: 38995601 DOI: 10.1007/s40121-024-01016-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Cefiderocol is a siderophore cephalosporin showing activity against various carbapenem-resistant Gram-negative bacteria (CR-GNB). No data currently exist about real-world use of cefiderocol in terms of types of therapy (e.g., empirical or targeted, monotherapy or combined regimens), indications, and patient characteristics. METHODS In this multicenter, prospective study, we aimed at describing the use of cefiderocol in terms of types of therapy, indications, and patient characteristics. RESULTS Cefiderocol was administered as empirical and targeted therapy in 27.5% (55/200) and 72.5% (145/200) of cases, respectively. Overall, it was administered as monotherapy in 101/200 cases (50.5%) and as part of a combined regimen for CR-GNB infections in the remaining 99/200 cases (49.5%). In multivariable analysis, previous isolation of carbapenem-resistant Acinetobacter baumannii odds ratio (OR) 2.56, with 95% confidence interval (95% CI) 1.01-6.46, p = 0.047] and previous hematopoietic stem cell transplantation (OR 8.73, 95% CI 1.05-72.54, p = 0.045) were associated with administration of cefiderocol as part of a combined regimen, whereas chronic kidney disease was associated with cefiderocol monotherapy (OR 0.38 for combined regimen, 95% CI 0.16-0.91, p = 0.029). Cumulative 30-day mortality was 19.8%, 45.0%, 20.7%, and 22.7% in patients receiving targeted cefiderocol for infections by Enterobacterales, A. baumannii, Pseudomonas aeruginosa, and any metallo-β-lactamase producers, respectively. CONCLUSIONS Cefiderocol is mainly used for targeted treatment, although empirical therapies account for more than 25% of prescriptions, thus requiring dedicated standardization and guidance. The almost equal distribution of cefiderocol monotherapy and cefiderocol-based combination therapies underlines the need for further study to ascertain possible differences in efficacy between the two approaches.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi, 10, 16132, Genoa, Italy.
| | - Laura Labate
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Chiara Russo Artimagnella
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Cristina Marelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Chiara Aldieri
- Infectious Diseases Unit, S. Croce e Carle Hospital, Cuneo, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Federica Briano
- SC Malattie Infettive e Tropicali, Ospedale San Paolo Savona, Savona, Italy
| | - Bruno Cacopardo
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | | | - Federico Capra Marzani
- SC AR1-Terapia Intensiva Generale, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Anna Carretta
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, University of Foggia, Foggia, Italy
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Luca Ceccarelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | | | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- Tufts University School of Medicine, Boston, MA, USA
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Analgesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy
| | - Rosario Cultrera
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Infectious Diseases, Azienda Unità Sanitaria Locale of Ferrara, Ferrara, Italy
| | | | - Valerio Del Bono
- Infectious Diseases Unit, S. Croce e Carle Hospital, Cuneo, Italy
| | | | - Chiara Fanelli
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Fiorenza Fava
- Anestesia e Terapia Intensiva Cardiotoracica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Nicholas Geremia
- Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale "dell'Angelo", Venice, Italy
- Unit of Infectious Diseases, Department of Clinical Medicine, Ospedale Civile "S.S. Giovanni e Paolo", Venice, Italy
| | - Lucia Graziani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Lombardi
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Angela Raffaella Losito
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ivana Maida
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Andrea Marino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | - Marco Merli
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberta Monardo
- Università Vita-Salute San Raffaele, Milan, Italy
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Carlo Pallotto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Francesca Raffaelli
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Matteo Rinaldi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Department of Integrated Management of Infectious Risk, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Marco Ripa
- Università Vita-Salute San Raffaele, Milan, Italy
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Teresa Antonia Santantonio
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, University of Foggia, Foggia, Italy
| | - Francesco Saverio Serino
- Azienda ULSS4 Veneto Orientale, UOS Malattie Infettive, UOC Medicina Generale Portogruaro, Portogruaro, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Torti
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Malattie Infettive, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Sez. Malattie Infettive, Rome, Italy
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, University "Magna Graecia", Catanzaro, Italy
- "R. Dulbecco" Teaching Hospital, Catanzaro, Italy
| | - Mario Tumbarello
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Infectious and Tropical Diseases Unit, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Anna Marchese
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- UO Microbiologia, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi, 10, 16132, Genoa, Italy
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Woods B, Schmitt L, Jankovic D, Kearns B, Scope A, Ren S, Srivastava T, Ku CC, Hamilton J, Rothery C, Bojke L, Sculpher M, Harnan S. Cefiderocol for treating severe aerobic Gram-negative bacterial infections: technology evaluation to inform a novel subscription-style payment model. Health Technol Assess 2024; 28:1-238. [PMID: 38938145 PMCID: PMC11229178 DOI: 10.3310/ygwr4511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Abstract
Background To limit the use of antimicrobials without disincentivising the development of novel antimicrobials, there is interest in establishing innovative models that fund antimicrobials based on an evaluation of their value as opposed to the volumes used. The aim of this project was to evaluate the population-level health benefit of cefiderocol in the NHS in England, for the treatment of severe aerobic Gram-negative bacterial infections when used within its licensed indications. The results were used to inform the National Institute for Health and Care Excellence guidance in support of commercial discussions regarding contract value between the manufacturer and NHS England. Methods The health benefit of cefiderocol was first derived for a series of high-value clinical scenarios. These represented uses that were expected to have a significant impact on patients' mortality risks and health-related quality of life. The clinical effectiveness of cefiderocol relative to its comparators was estimated by synthesising evidence on susceptibility of the pathogens of interest to the antimicrobials in a network meta-analysis. Patient-level costs and health outcomes of cefiderocol under various usage scenarios compared with alternative management strategies were quantified using decision modelling. Results were reported as incremental net health effects expressed in quality-adjusted life-years, which were scaled to 20-year population values using infection number forecasts based on data from Public Health England. The outcomes estimated for the high-value clinical scenarios were extrapolated to other expected uses for cefiderocol. Results Among Enterobacterales isolates with the metallo-beta-lactamase resistance mechanism, the base-case network meta-analysis found that cefiderocol was associated with a lower susceptibility relative to colistin (odds ratio 0.32, 95% credible intervals 0.04 to 2.47), but the result was not statistically significant. The other treatments were also associated with lower susceptibility than colistin, but the results were not statistically significant. In the metallo-beta-lactamase Pseudomonas aeruginosa base-case network meta-analysis, cefiderocol was associated with a lower susceptibility relative to colistin (odds ratio 0.44, 95% credible intervals 0.03 to 3.94), but the result was not statistically significant. The other treatments were associated with no susceptibility. In the base case, patient-level benefit of cefiderocol was between 0.02 and 0.15 quality-adjusted life-years, depending on the site of infection, the pathogen and the usage scenario. There was a high degree of uncertainty surrounding the benefits of cefiderocol across all subgroups. There was substantial uncertainty in the number of infections that are suitable for treatment with cefiderocol, so population-level results are presented for a range of scenarios for the current infection numbers, the expected increases in infections over time and rates of emergence of resistance. The population-level benefits varied substantially across the base-case scenarios, from 896 to 3559 quality-adjusted life-years over 20 years. Conclusion This work has provided quantitative estimates of the value of cefiderocol within its areas of expected usage within the NHS. Limitations Given existing evidence, the estimates of the value of cefiderocol are highly uncertain. Future work Future evaluations of antimicrobials would benefit from improvements to NHS data linkages; research to support appropriate synthesis of susceptibility studies; and application of routine data and decision modelling to assess enablement value. Study registration No registration of this study was undertaken. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment Policy Research Programme (NIHR award ref: NIHR135591), conducted through the Policy Research Unit in Economic Methods of Evaluation in Health and Social Care Interventions, PR-PRU-1217-20401, and is published in full in Health Technology Assessment; Vol. 28, No. 28. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Beth Woods
- Centre for Health Economics, University of York, York, UK
| | | | - Dina Jankovic
- Centre for Health Economics, University of York, York, UK
| | - Benjamin Kearns
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Shijie Ren
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tushar Srivastava
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Chu Chang Ku
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Claire Rothery
- Centre for Health Economics, University of York, York, UK
| | - Laura Bojke
- Centre for Health Economics, University of York, York, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Sue Harnan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Petrucci F, Perciballi B, Rivano Capparuccia M, Iaiani G, Lo Torto F, Ribuffo D, Gumina S, De Meo D. Compassionate use of cefiderocol in a complex case of extensively drug-resistant Acinetobacter baumannii fracture-related infection: a comprehensive approach and multidisciplinary management. Infection 2024:10.1007/s15010-024-02294-x. [PMID: 38748180 DOI: 10.1007/s15010-024-02294-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/07/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Fracture-related infections (FRI) pose a difficult management problem, as they require numerous surgical interventions and extended antibiotic treatments, especially when a multidrug-resistant organism is involved, with a paucity of available literature that provides guidance. RESULTS A 42 year-old male presents an open diaphyseal tibia and fibula fracture, complicated by soft tissue necrosis and infections caused by extensively drug-resistant Acinetobacter baumannii (XDR-Ab). Initially treated with a damage control external fixator, the patient underwent multiple surgical procedures, including radical debridement, negative pressure wound therapy, external fixator revisions and reconstructive surgery using a latissimus dorsi free flap. The emergence of colistin resistance in the Acinetobacter baumannii strain led to the compassionate use of cefiderocol, finally achieving clinical cure. CONCLUSIONS This case report is one of the firsts that highlights the potential efficacy of cefiderocol in treating challenging bone and joint infections sustained by XDR-Ab. The successful outcome also emphasizes the importance of a comprehensive, multidisciplinary approach in achieving favorable results in complex FRI.
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Affiliation(s)
- Flavia Petrucci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185, Rome, Italy.
- M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Beatrice Perciballi
- M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
- Department of Anatomical, Forensic Medicine and Musculoskeletal System Sciences, Sapienza University of Rome, 00161, Rome, Italy
| | - Marco Rivano Capparuccia
- M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
- Department of Internal Medicine, Endocrine-Metabolic Sciences and Infectious Diseases, Policlinico Umberto I University Hospital, 00161, Rome, Italy
| | - Giancarlo Iaiani
- M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
- Department of Internal Medicine, Endocrine-Metabolic Sciences and Infectious Diseases, Policlinico Umberto I University Hospital, 00161, Rome, Italy
| | - Federico Lo Torto
- M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
- Plastic Surgery Unit, Department of General Surgery, Plastic Surgery, Orthopedics Policlinico Umberto I Hospital-Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Diego Ribuffo
- M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
- Plastic Surgery Unit, Department of General Surgery, Plastic Surgery, Orthopedics Policlinico Umberto I Hospital-Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Stefano Gumina
- Department of Anatomical, Forensic Medicine and Musculoskeletal System Sciences, Sapienza University of Rome, 00161, Rome, Italy
| | - Daniele De Meo
- M.I.T.O. (Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
- Department of Anatomical, Forensic Medicine and Musculoskeletal System Sciences, Sapienza University of Rome, 00161, Rome, Italy
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Fischer M, Nonnenmacher L, Reichert JC, Bohnert JA, Idelevich EA, Doğan E, Becker K, Wassilew GI. Case Report: Hip arthroplasty after fracture-related joint infection caused by extensively drug-resistant Klebsiella pneumoniae. Front Surg 2024; 11:1363298. [PMID: 38476757 PMCID: PMC10927804 DOI: 10.3389/fsurg.2024.1363298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
This case-report focuses on a 23-year-old soldier suffering from a fracture-related hip joint infection (FRI) due to extensively drug-resistant Klebsiella pneumoniae and S. epidermidis. The patient underwent multiple septic revision surgeries including the removal of remaining shrapnel accompanied by last-resort antimicrobial therapy with cefiderocol and colistin. Additionally, the surgeries included repeated tissue sampling for microbiological and histopathological analysis. An antibiotic-loaded cemented filler containing cefiderocol was used to improve local antimicrobial therapy. The biopsies prior to and during hip replacement surgery confirmed successful microbe eradication. Hip arthroplasty restored hip joint function and significantly improved patient's quality of life. The utilization of a trabecular metal shell and a meta-diaphyseally anchored cementless hip stem ensured secure implant fixation and early patient mobilisation. An adjusted biofilm active oral antimicrobial therapy after arthroplasty intervention was continued to prevent early periprosthetic joint infection. This case emphasizes the difficulties of managing FRI and multidrug-resistant pathogens. It contributes valuable insight into navigating complex orthopedic cases while ensuring successful hip arthroplasty outcomes. In conclusion, early interdisciplinary collaboration, appropriate antimicrobial therapy along with tailored surgical interventions are crucial for managing such complex cases successfully.
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Affiliation(s)
- Maximilian Fischer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Lars Nonnenmacher
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Johannes C. Reichert
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jürgen A. Bohnert
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Evgeny A. Idelevich
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Eyüp Doğan
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Karsten Becker
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
| | - Georgi I. Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
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Wang L, Zhu J, Chen L, Du H. Cefiderocol: Clinical application and emergence of resistance. Drug Resist Updat 2024; 72:101034. [PMID: 38134561 DOI: 10.1016/j.drup.2023.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
Antibacterial drug resistance of gram-negative bacteria (GNB) results in high morbidity and mortality of GNB infection, seriously threaten human health globally. Developing new antibiotics has become the critical need for dealing with drug-resistant bacterial infections. Cefiderocol is an iron carrier cephalosporin that achieves drug accumulation through a unique "Trojan horse" strategy into the bacterial periplasm. It shows high antibacterial activity against multidrug-resistant (MDR) Enterobacteriaceae and MDR non-fermentative bacteria. The application of cefiderocol offers new hope for treating clinical drug-resistant bacterial infections. However, limited clinical data and uncertainties about its resistance mechanisms constrain the choice of its therapeutic use. This review aimed to summarize the clinical applications, drug resistance mechanisms, and co-administration of cefiderocol.
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Affiliation(s)
- Liang Wang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, China; MOE Key Laboratory of Geriatric Diseases and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215123 China
| | - Jie Zhu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Liang Chen
- Hackensack Meridian Health Center for Discovery and Innovation, Nutley, NJ, United States; Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ, United States
| | - Hong Du
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, China; MOE Key Laboratory of Geriatric Diseases and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215123 China.
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Giannella M, Verardi S, Karas A, Abdel Hadi H, Dupont H, Soriano A, Santerre Henriksen A, Cooper A, Falcone M. Carbapenem-Resistant Acinetobacter spp Infection in Critically Ill Patients With Limited Treatment Options: A Descriptive Study of Cefiderocol Therapy During the COVID-19 Pandemic. Open Forum Infect Dis 2023; 10:ofad329. [PMID: 37496600 PMCID: PMC10368198 DOI: 10.1093/ofid/ofad329] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023] Open
Abstract
Background Carbapenem-resistant Acinetobacter baumannii infections are difficult to treat and are a significant public health threat due to intrinsic/acquired resistance and limited treatment options. Methods A retrospective, observational cohort study in patients receiving cefiderocol via Shionogi's early access program for Acinetobacter spp infections (1 April 2020-30 April 2021; 27 sites; Italy, Spain, Germany, France). Primary outcome was clinical success, defined as clinical resolution of infection at day 14 or day 28 survival. Results Overall, 147 patients were included. Primary infection sites were respiratory (65.3%) and bloodstream (unknown source [15.6%]; catheter-related [10.9%]); 24.5% of patients had polymicrobial infection. Of 136 patients in intensive care (92.5%), 85.3% (116/136) received mechanical ventilation. Septic shock (55.6% [70/126]) and coronavirus disease 2019 (COVID-19) (81.6%) were prevalent. Prior to cefiderocol, 85.0% of patients received gram-negative treatment, 61.2% received ≥2 antimicrobials, and most received colistin (58.5%; median duration, 11.5 days). Cefiderocol monotherapy was used in 30.6% of patients. Clinical success rate was 53.1% and was higher in patients without septic shock (62.5%), without COVID-19 (77.8%), and with lower Sequential Organ Failure Assessment (SOFA) scores (quartile 1 [median, 3; range, 0-5]: 82.9%). Day 28 survival was 44.9% and was higher in patients without septic shock (60.7%), without COVID-19 (59.3%), with lower SOFA score (quartile 1: 82.9%), and receiving first-line cefiderocol (68.2% [15/22]). Resolution of infection at day 14 occurred in 39.5% of patients. Conclusions Despite use in complex patients with limited treatment options and high septic shock/COVID-19 rates, cefiderocol treatment was associated with an overall clinical success rate of 53%.
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Affiliation(s)
- Maddalena Giannella
- Correspondence: Maddalena Giannella, MD, PhD, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico di Sant'Orsola, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 11, Bologna 40138, Italy (); Andreas Karas, MD, Medical Affairs, Shionogi B.V., 33 Kingsway, London WC2B 6UF, UK ()
| | | | - Andreas Karas
- Correspondence: Maddalena Giannella, MD, PhD, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico di Sant'Orsola, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 11, Bologna 40138, Italy (); Andreas Karas, MD, Medical Affairs, Shionogi B.V., 33 Kingsway, London WC2B 6UF, UK ()
| | - Hasania Abdel Hadi
- Unidad de Cuidados Intensivos, Hospital General Universitario, Ciudad Real, Spain
| | - Hervé Dupont
- Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire d’Amiens Picardie, Amiens, France
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Barcelona, Spain
| | | | - Andrew Cooper
- Global Epidemiology and Real-World Evidence, Shionogi B.V., London, United Kingdom
| | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Viale P, Sandrock CE, Ramirez P, Rossolini GM, Lodise TP. Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidence. Ann Intensive Care 2023; 13:52. [PMID: 37322293 DOI: 10.1186/s13613-023-01146-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
Appropriate antibiotic treatment for critically ill patients with serious Gram-negative infections in the intensive care unit is crucial to minimize morbidity and mortality. Several new antibiotics have shown in vitro activity against carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat resistant Pseudomonas aeruginosa. Cefiderocol is the first approved siderophore beta-lactam antibiotic with potent activity against multidrug-resistant, carbapenem-resistant, difficult-to-treat or extensively drug-resistant Gram-negative pathogens, which have limited treatment options. The spectrum of activity of cefiderocol includes drug-resistant strains of Acinetobacter baumannii, P. aeruginosa, Stenotrophomonas maltophilia, Achromobacter spp. and Burkholderia spp. and CRE that produce serine- and/or metallo-carbapenemases. Phase 1 studies established that cefiderocol achieves adequate concentration in the epithelial lining fluid in the lung and requires dosing adjustment for renal function, including patients with augmented renal clearance and continuous renal-replacement therapy (CRRT); no clinically significant drug-drug interactions are expected. The non-inferiority of cefiderocol versus high-dose, extended-infusion meropenem in all-cause mortality (ACM) rates at day 14 was demonstrated in the randomized, double-blind APEKS-NP Phase 3 clinical study in patients with nosocomial pneumonia caused by suspected or confirmed Gram-negative bacteria. Furthermore, the efficacy of cefiderocol was investigated in the randomized, open-label, pathogen-focused, descriptive CREDIBLE-CR Phase 3 clinical study in its target patient population with serious carbapenem-resistant Gram-negative infections, including hospitalized patients with nosocomial pneumonia, bloodstream infection/sepsis, or complicated urinary tract infections. However, a numerically greater ACM rate with cefiderocol compared with BAT led to the inclusion of a warning in US and European prescribing information. Cefiderocol susceptibility results obtained with commercial tests should be carefully evaluated due to current issues regarding their accuracy and reliability. Since its approval, real-world evidence in patients with multidrug-resistant and carbapenem-resistant Gram-negative bacterial infections suggests that cefiderocol can be efficacious in certain critically ill patient groups, such as those requiring mechanical ventilation for COVID-19 pneumonia with subsequently acquired Gram-negative bacterial superinfection, and patients with CRRT and/or extracorporeal membrane oxygenation. In this article, we review the microbiological spectrum, pharmacokinetics/pharmacodynamics, efficacy and safety profiles and real-world evidence for cefiderocol, and look at future considerations for its role in the treatment of critically ill patients with challenging Gram-negative bacterial infections.
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Affiliation(s)
- Pierluigi Viale
- Infectious Disease Unit, IRCCS Policlinico di Sant'Orsola, Bologna, Italy
- Department of Medical and Surgical Science, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Christian E Sandrock
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.
| | - Paula Ramirez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Thomas P Lodise
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
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Mazzitelli M, Gregori D, Sasset L, Trevenzoli M, Scaglione V, Lo Menzo S, Marinello S, Mengato D, Venturini F, Tiberio I, Navalesi P, Cattelan A. Cefiderocol-Based versus Colistin-Based Regimens for Severe Carbapenem-Resistant Acinetobacter baumannii Infections: A Propensity Score-Weighted, Retrospective Cohort Study during the First Two Years of the COVID-19 Pandemic. Microorganisms 2023; 11:microorganisms11040984. [PMID: 37110408 PMCID: PMC10146662 DOI: 10.3390/microorganisms11040984] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND A large increase in multi-drug-resistant Acinetobacter baumannii, especially carbapenem-resistant strains, occurred during the first two years of the COVID-19 pandemic, posing important challenges in its treatment. Cefiderocol appeared to be a good option for the treatment of Carbapenem-resistant Acinetobacter baumannii (CR-Ab), but to date, the guidelines and evidence available are conflicting. METHODS We retrospectively included a group of patients with CR-Ab infections (treated with colistin- or cefiderocol-based regimens) at Padua University Hospital (August 2020-July 2022) and assessed predictors of 30-day mortality, and differences in microbiological and clinical treatment. To evaluate the difference in outcomes, accounting for the imbalance in antibiotic treatment allocation, a propensity score weighting (PSW) approach was adopted. RESULTS We included 111 patients, 68% males, with a median age of 69 years (IQR: 59-78). The median duration of antibiotic treatment was 13 days (IQR:11-16). In total, 60 (54.1%) and 51 (45.9%) patients received cefiderocol- and colistin-based therapy, respectively. Notably, 53 (47.7%) patients had bloodstream infections, while 58 (52.3%) had pneumonia. Colistin was combined in 96.1%, 80.4%, and 5.8% of cases with tigecycline, meropenem, and fosfomycin, respectively. Cefiderocol was combined in 13.3%, 30%, and 18.3% of cases with fosfomycin, tigecycline, and meropenem, respectively. At the baseline, the two treatment groups significantly differed in age (patients treated with colistin were significantly older), the prevalence of diabetes and obesity (more frequent in the group treated with colistin), length of stay (longer in the group receiving cefiderocol), and type of infection (BSI were more frequent in the group receiving cefiderocol). The proportion of patients who developed acute kidney injury was significantly higher in the colistin group. By using PSW, no statistically significant differences emerged for mortality or clinical and microbiological cure between the two groups. No independent predictors were detected for hospital mortality or clinical cure, while for the length of stay, the only selected predictor was age, with a non-linear effect (p-value 0.025 for non-linearity) on the prolongation of hospital stay of 0.25 days (95% CI 0.10-0.39) at increasing ages (calculated over the IQR). CONCLUSIONS Cefiderocol treatment did not differ in terms of main outcomes and safety profile from colistin-based regimens. More prospective studies with a larger number of patients are required to confirm our results.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, DCTVPH, University of Padova, 35128 Padua, Italy
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Marco Trevenzoli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Sara Lo Menzo
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Serena Marinello
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Daniele Mengato
- Hospital Pharmacy Unit, Padua University Hospital, 35128 Padua, Italy
| | | | - Ivo Tiberio
- Anesthesiology and Intensive Care Unit, Padua University Hospital, 35128 Padua, Italy
| | - Paolo Navalesi
- Department of Medicine (DIMED), Padua University Hospital, 35121 Padua, Italy
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
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Fendian ÁM, Albanell-Fernández M, Tuset M, Pitart C, Castro P, Soy D, Bodro M, Soriano A, Del Río A, Martínez JA. Real-Life Data on the Effectiveness and Safety of Cefiderocol in Severely Infected Patients: A Case Series. Infect Dis Ther 2023; 12:1205-1216. [PMID: 36943617 PMCID: PMC10029777 DOI: 10.1007/s40121-023-00776-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/08/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Real-life data about cefiderocol use to treat extensively drug-resistant bacteria are scarce. We aim to report our early experience in patients with difficult-to-treat infections and limited therapeutic options. METHODS Patients treated with cefiderocol from March 2018 to April 2022 in a tertiary-care hospital in Spain were included. Demographic, clinical, and microbiological data were collected up to 90 days after the end of treatment or until death. Survival status was recorded at 30 and 90 days. RESULTS Ten patients were included, seven of them critically ill. Ventilator-associated pneumonia (40%) and bacteremia (40%) were the main infections. Multidrug-resistant or extensively drug-resistant P. aeruginosa was the most frequently isolated pathogen (70%, of which six patients were infected with bacteria with difficult-to-treat resistance), followed by A. baumannii, E. coli, and A. xylosoxidans (10% each). Seven patients received combination therapy. Clinical and microbiological cures were achieved in 90% and 80% of patients, respectively. Two previously susceptible strains (20%) developed resistance to cefiderocol. Overall, 30-day and 90-day mortality rates were 10% and 50%, respectively, although two out of five patients died due to the infection. No serious adverse events were reported, except for one patient who developed thrombocytopenia. CONCLUSION Cefiderocol seems to be an effective and safe rescue therapy for patients infected with difficult-to-treat pathogens, although there is a definite risk of the emergence of resistance.
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Affiliation(s)
- Ángel Marcos Fendian
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain.
| | | | - Montse Tuset
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Cristina Pitart
- Department of Microbiology, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Dolors Soy
- Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Pharmacology, Toxicology and Therapeutic Chemistry, School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ana Del Río
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
| | - José Antonio Martínez
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Clinical Appraisal of Cefiderocol in the Treatment of Non-fermenting Gram-Negative Bacilli. Curr Infect Dis Rep 2023. [DOI: 10.1007/s11908-023-00800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Abstract
Purpose of Review
Cefiderocol has a potential role in the treatment of infections caused by increasingly resistant non-fermenting Gram-negative organisms.
Recent Findings
Non-fermenting Gram-negative organisms pose a unique threat to public health given their arsenal of inherent resistance mechanisms. High rates of intrinsic resistance to a wide array of agents, inducible adaptive resistance, and the ability to acquire resistance through horizontal transfer of resistance genes limit the utility of conventional antimicrobial treatment options against non-fermenting Gram-negative infections. Beta-lactams, one of the most reliable classes of antimicrobials, are often rendered inactive by the acquisition of beta-lactamases, with activity potentially restored by beta-lactamase inhibitors. Alteration of intrinsic mechanisms of resistance, porin channels, and efflux pumps reduce the ability of beta-lactamase inhibitors to protect the activity of beta-lactams. This multifactorial nature of resistance exhibited by non-fermenting Gram-negative organisms is difficult to overcome and novel agents are needed to combat this growing threat.
Summary
Cefiderocol is a novel siderophore cephalosporin that utilizes the active transport of ferric iron to gain access to the periplasmic space of Gram-negative organisms. Cefiderocol also has additional modifications that confer some stability in the presence of beta-lactamases, which can be particularly beneficial for infections caused by non-fermenters. Herein, we discuss the potential role of cefiderocol therapy in the management of infections caused by non-fermenting Gram-negative bacilli, with an intentional focus on carbapenem-resistant Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa, and Stenotrophomonas spp.
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Witzke O, Brenner T. [Clinical experience using cefiderocol]. Med Klin Intensivmed Notfmed 2023; 118:149-155. [PMID: 35913604 PMCID: PMC9341408 DOI: 10.1007/s00063-022-00925-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infections due to antibiotic-resistant bacteria are threatening modern healthcare, and antibacterial resistance has become one of the greatest threats to public health. In Germany 54,500 patients become infected with antibiotic-resistant bacteria per year, causing about 2400 attributable deaths. Rising resistance in Gram-negative bacteria especially carbapenem-resistant pathogens is of particular concern due to the lack of effective and safe alternative treatment options. OBJECTIVE The results from trials and compassionate-use programs with the new antibiotic cefiderocol, which was approved by the European Medicines Agency (EMA) in April 2020 for the treatment of adults with infections caused by aerobic Gram-negative bacteria, are summarized. RESULTS The new β‑lactam antibiotic cefiderocol is the first siderophore cephalosporin indicated for the treatment of infections due to aerobic Gram-negative organisms in adults with limited treatment options. Its chemical structure and its unique mechanism of action confer enhanced stability against β‑lactamases including all classes of clinically relevant carbapenemases. In vitro data show high antibacterial activity against multidrug resistant Gram-negative bacteria, Enterobacterales and nonfermenters, including carbapenem-resistant strains. In clinical trials, cefiderocol showed superiority in complicated urinary tract infection in comparison to imipenem and non-inferiority versus meropenem in hospital-acquired/ventilator-associated pneumonia patients and severe infections caused by carbapenem-resistant pathogens. CONCLUSION Clinical trial data and case reports identified in the literature search show that cefiderocol is a promising treatment option for severe infections caused by drug-resistant Gram-negative bacteria, particularly carbapenem-resistant bacteria.
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Affiliation(s)
- Oliver Witzke
- Klinik für Infektiologie, Westdeutsches Zentrum für Infektiologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
| | - Thorsten Brenner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
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Jean SS, Liu IM, Hsieh PC, Kuo DH, Liu YL, Hsueh PR. Off-label use versus formal recommendations of conventional and novel antibiotics for the treatment of infections caused by multidrug-resistant bacteria. Int J Antimicrob Agents 2023; 61:106763. [PMID: 36804370 DOI: 10.1016/j.ijantimicag.2023.106763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 02/19/2023]
Abstract
The infections caused by multidrug- and extensively drug-resistant (MDR, XDR) bacteria, including Gram-positive cocci (GPC, including methicillin-resistant Staphylococcus aureus, MDR-Streptococcus pneumoniae and vancomycin-resistant enterococci) and Gram-negative bacilli (GNB, including carbapenem-resistant [CR] Enterobacterales, CR-Pseudomonas aeruginosa and XDR/CR-Acinetobacter baumannii complex) can be quite challenging for physicians with respect to treatment decisions. Apart from complicated urinary tract and intra-abdominal infections (cUTIs, cIAIs), bloodstream infections and pneumonia, these difficult-to-treat bacteria also cause infections at miscellaneous sites (bones, joints, native/prosthetic valves and skin structures, etc.). Antibiotics like dalbavancin, oritavancin, telavancin and daptomycin are currently approved for the treatment of acute bacterial skin and skin structural infections (ABSSSIs) caused by GPC. Additionally, ceftaroline, linezolid and tigecycline have been formally approved for the treatment of community-acquired pneumonia and ABSSSI. Cefiderocol and meropenem-vaborbactam are currently approved for the treatment of cUTIs caused by XDR-GNB. The spectra of ceftazidime-avibactam and imipenem/cilastatin-relebactam are broader than that of ceftolozane-tazobactam, but these three antibiotics are currently approved for the treatment of hospital-acquired pneumonia, cIAIs and cUTIs caused by MDR-GNB. Clinical investigations of other novel antibiotics (including cefepime-zidebactam, aztreonam-avibactam and sulbactam-durlobactam) for the treatment of various infections are ongoing. Nevertheless, evidence for adequate antibiotic regimens against osteomyelitis, arthritis and infective endocarditis due to several GPC and MDR-GNB is still mostly lacking. A comprehensive review of PubMed publications was undertaken and the formal indications and off-label use of important conventional and novel antibiotics against MDR/XDR-GPC and GNB isolates cultured from miscellaneous sites are presented in this paper.
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Affiliation(s)
- Shio-Shin Jean
- Departments of Internal Medicine and Critical Care Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan; Department of Pharmacy, College of Pharmacy and Health care, Tajen University, Pingtung, Taiwan
| | - I-Min Liu
- Department of Pharmacy, College of Pharmacy and Health care, Tajen University, Pingtung, Taiwan
| | - Po-Chuen Hsieh
- Department of Pharmacy, College of Pharmacy and Health care, Tajen University, Pingtung, Taiwan
| | - Dai-Huang Kuo
- Department of Pharmacy, College of Pharmacy and Health care, Tajen University, Pingtung, Taiwan
| | - Yi-Lien Liu
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan; Department of Public Health, Taoyuan City Government, Taoyuan, Taiwan
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; PhD Program for Aging, School of Medicine, China Medical University, Taichung, Taiwan; Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Urmann E, Stamm P, Wisskirchen J. [Cefiderocol in AML patient with neutropenic infection due to 4MRGN Klebsiella pneumoniae (VIM-1)]. Dtsch Med Wochenschr 2023; 148:170-174. [PMID: 36750128 DOI: 10.1055/a-1975-2594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ANAMNESIS The 68-year-old patient presented with fever, general malaise and physical weakness in neutropenia during a known relapse of acute myeloid leukaemia after allogeneic stem cell transplantation. TREATMENT/DIAGNOSIS Due to immune suppression, an empiric antibiotic therapy with piperacillin/tazobactam was started. The 4MRGN screening was positive. For this reason, therapy was switched empirically to ceftazidime/avibactam plus colistin. A tongue ulcer with abscess formation and phlegmonous soft tissue reaction was revealed as the focus of the infection. Several microbiological probes including a blood culture discovered Klebsiella pneumoniae complex - 4MRGN that expressed a metallo-beta-lactamase of the VIM-1 type (Verona integron metallo betalactamase-1). A permanent improvement of the clinical symptoms and regredience of the infection parameters could only be achieved after antibiotic treatment was switched to the recently approved siderophor cephalosporin cefiderocol. After 18 days the antibiotic treatment could be completed successfully. The patient was discharged in a stable condition. CONCLUSION 4MRGN pathogens are Gram-negative rod-shaped bacteria that are resistant against four main bactericidal antibiotic groups (Acylureidopenicillins, 3rd generation cephalosporins, carbapenems, and fluoroquinolones) and thus difficult to treat. The present case demonstrates good clinical efficacy for cefiderocol even in pathogens resistant to antibiotics such as colistin and ceftazidime/avibactam and highlights the importance of antibiogram-tailored therapy.
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Affiliation(s)
- Emanuel Urmann
- Universitätsmedizin Mainz, III. Medizinische Klinik und Poliklinik, Hämatologie und medizinische Onkologie
| | - Paul Stamm
- Universitätsmedizin Mainz, Zentrum für Kardiologie - Kardiologie 1
| | - Jonas Wisskirchen
- Universitätsmedizin Mainz, III. Medizinische Klinik und Poliklinik, Hämatologie und medizinische Onkologie
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Gavaghan V, Miller JL, Dela-Pena J. Case series of cefiderocol for salvage therapy in carbapenem-resistant Gram-negative infections. Infection 2022; 51:475-482. [PMID: 36201152 PMCID: PMC9540105 DOI: 10.1007/s15010-022-01933-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/23/2022] [Indexed: 11/28/2022]
Abstract
Purpose This case series describes real-world utilization of cefiderocol and associated clinical outcomes in the setting of carbapenem-resistant Gram-negative bacterial infections.
Methods Adult hospitalized patients administered at least 5 days of cefiderocol as definitive treatment from October 1, 2020 to September 16, 2021 were included in this retrospective cohort analysis. The primary outcome was clinical success defined as a composite of 30 day survival, resolution of infection, and absence of 30 day recurrence of the same organism.
Results Among 24 patients, pneumonia (19, 79%) was the most common source of infection with Acinetobacter baumannii (14, 58%) and P. aeruginosa (10, 42%) as the predominant organisms isolated. Cefiderocol monotherapy was used as definitive treatment in 16 (67%) patients. Eleven patients (46%) met clinical success. Thirty-day mortality occurred in ten (42%) patients while seven (29%) patients had recurrence of infection. Thirteen out of 21 total isolates (62%) tested for susceptibility were deemed susceptible. Of the 16 patients with available susceptibility, 9 (56%) had an infection where all isolated organisms were susceptible to cefiderocol. Conclusions Our results provide additional insight into the in vivo activity of cefiderocol. Cefiderocol remains a salvage option for carbapenem-resistant Gram-negative organisms.
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Affiliation(s)
- Victoria Gavaghan
- Department of Pharmacy, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA.
| | - Jessica L Miller
- Department of Pharmacy, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL, 60068, USA
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Hetzler L, Kollef MH, Yuenger V, Micek ST, Betthauser KD. New antimicrobial treatment options for severe Gram-negative infections. Curr Opin Crit Care 2022; 28:522-533. [PMID: 35942725 DOI: 10.1097/mcc.0000000000000968] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review will provide rationale for the development of new antibiotics to treat severe or multidrug-resistant (MDR) Gram-negative infections. It will also provide an overview of recently approved and pipeline antibiotics for severe/MDR Gram-negative infections. RECENT FINDINGS MDR Gram-negative infections are recognized as critical threats by global and national organizations and carry a significant morbidity and mortality risk. Increasing antibiotic resistance amongst Gram-negative bacteria, including carbapenem-resistant Acinetobacter baumannii , extended-spectrum β-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa , with difficult-to-treat-resistance has made both empiric and definitive treatment of these infections increasingly problematic. In recent years, several antibiotics have been approved for treatment of MDR Gram-negative infections and ongoing clinical trials are poised to provide additional options to clinicians' armamentarium. These agents include various β-lactam/β-lactamase inhibitor combinations, eravacycline, plazomicin and cefiderocol. SUMMARY Severe/MDR Gram-negative infections continue to be important infections due to their impact on patient outcomes, especially in critically ill and immunocompromised hosts. The availability of new antibiotics offers an opportunity to improve empiric and definitive treatment of these infections.
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Affiliation(s)
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine
| | | | - Scott T Micek
- Department of Pharmacy Practice, Barnes-Jewish Hospital
- Department of Pharmacy Practice
- Center for Health Outcomes Research and Education, University of Health Sciences and Pharmacy, St. Louis, Missouri, USA
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Canton R, Doi Y, Simner PJ. Treatment of carbapenem-resistant Pseudomonas aeruginosa infections: a case for cefiderocol. Expert Rev Anti Infect Ther 2022; 20:1077-1094. [PMID: 35502603 DOI: 10.1080/14787210.2022.2071701] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/26/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Carbapenem-resistant (CR) Pseudomonas aeruginosa infections constitute a serious clinical threat globally. Patients are often critically ill and/or immunocompromised. Antibiotic options are limited and are currently centered on beta-lactam-beta-lactamase inhibitor (BL-BLI) combinations and the siderophore cephalosporin cefiderocol. AREAS COVERED This article reviews the mechanisms of P. aeruginosa resistance and their potential impact on the activity of current treatment options, along with evidence for the clinical efficacy of BL-BLI combinations in P. aeruginosa infections, some of which specifically target infections due to CR organisms. The preclinical and clinical evidence supporting cefiderocol as a treatment option for P. aeruginosa involving infections is also reviewed. EXPERT OPINION Cefiderocol is active against most known P. aeruginosa mechanisms mediating carbapenem resistance. It is stable against different serine- and metallo-beta-lactamases, and, due to its iron channel-dependent uptake mechanism, is not impacted by porin channel loss. Furthermore, the periplasmic level of cefiderocol is not affected by upregulated efflux pumps. The potential for on-treatment resistance development currently appears to be low, although more clinical data are required. Information from surveillance programs, real-world compassionate use, and clinical studies demonstrate that cefiderocol is an important treatment option for CR P. aeruginosa infections.
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Affiliation(s)
- Rafael Canton
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Yohei Doi
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Patricia J Simner
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Sansone P, Giaccari LG, Coppolino F, Aurilio C, Barbarisi A, Passavanti MB, Pota V, Pace MC. Cefiderocol for Carbapenem-Resistant Bacteria: Handle with Care! A Review of the Real-World Evidence. Antibiotics (Basel) 2022; 11:antibiotics11070904. [PMID: 35884158 PMCID: PMC9311995 DOI: 10.3390/antibiotics11070904] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 01/27/2023] Open
Abstract
(1) Background: healthcare-associated infections are one of the most frequent adverse events in healthcare delivery worldwide. Several antibiotic resistance mechanisms have been developed, including those to carbapenemase. Cefiderocol (CFD) is a novel siderophore cephalosporin designed to treat carbapenem-resistant bacteria. (2) Methods: we performed a systematic review of all cases reported in the literature to outline the existing evidence. We evaluated real-world evidence studies of CFD in the treatment of carbapenem-resistant (CR) bacteria. (3) Results: a total of 19 publications treating cases of infection by CR bacteria were included. The three most frequent CR pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae. A regimen of 2 g every 8 h was most frequently adopted for CFD with a mean treatment duration of 25.6 days. CFD was generally well tolerated, with fewer side effects. The success rate of CFD therapy was satisfactory and almost 70% of patients showed clinical recovery; of these, nearly half showed negative blood cultures and infection-free status. (4) Conclusions: This review indicates that CFD is active against important GN organisms including Enterobacteriaceae, P. aeruginosa, and A. baumannii. CFD seems to have a safe profile.
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Affiliation(s)
- Pasquale Sansone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.G.); (F.C.); (C.A.); (M.B.P.); (V.P.); (M.C.P.)
- Correspondence: ; Tel.: +39-08-1566-5180
| | - Luca Gregorio Giaccari
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.G.); (F.C.); (C.A.); (M.B.P.); (V.P.); (M.C.P.)
| | - Francesco Coppolino
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.G.); (F.C.); (C.A.); (M.B.P.); (V.P.); (M.C.P.)
| | - Caterina Aurilio
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.G.); (F.C.); (C.A.); (M.B.P.); (V.P.); (M.C.P.)
| | - Alfonso Barbarisi
- Department of Translational Medical Science, Telematic University Pegaso, 80138 Naples, Italy;
| | - Maria Beatrice Passavanti
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.G.); (F.C.); (C.A.); (M.B.P.); (V.P.); (M.C.P.)
| | - Vincenzo Pota
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.G.); (F.C.); (C.A.); (M.B.P.); (V.P.); (M.C.P.)
| | - Maria Caterina Pace
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (L.G.G.); (F.C.); (C.A.); (M.B.P.); (V.P.); (M.C.P.)
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18
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Babidhan R, Lewis A, Atkins C, Jozefczyk NJ, Nemecek BD, Montepara CA, Gionfriddo MR, Zimmerman DE, Covvey JR, Guarascio AJ. Safety and efficacy of cefiderocol for off-label treatment indications: A systematic review. Pharmacotherapy 2022; 42:549-566. [PMID: 35611627 DOI: 10.1002/phar.2704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Cefiderocol is a siderophore cephalosporin recently approved by the United States Food and Drug Administration for the treatment of hospital- and ventilator-acquired bacterial pneumonia and complicated urinary tract infections. However, there is potential for cefiderocol utility for a variety of other infections. The purpose of this systematic review was to identify literature examining the safety and efficacy of cefiderocol for off-label indications. METHODS The PRISMA guidelines were utilized for reporting. Databases searched included PubMed, Scopus, and Embase, from inception to September 2021. Manuscripts describing cefiderocol off-label use in clinical settings were included. Exclusion criteria were studies focused on labeled indications, animal studies, pharmacodynamic/pharmacokinetic studies, in vitro or laboratory studies, and manuscripts in languages other than English or Arabic. Each stage of review utilized two independent investigators, with conflicts resolved and critical appraisal performed. Data regarding presentation, clinical course, and infection characteristics were extracted and descriptively analyzed. RESULTS The search identified a total of 985 records, narrowed to a final set of 27 studies. Among studies included were 18 (66.7%) case reports, 8 (29.6%) case series, and 1 (3.7%) phase 3 clinical trial. Cefiderocol was most frequently used off-label for bacteremia/sepsis with or without an identified source in 51 (67.1%) out of a total of 76 included patients. Among case series/reports with available data, 43 of 53 patients (81.1%) received combination antibiotic therapy. The most common pathogens identified included multi/extensively drug-resistant Pseudomonas aeruginosa and/or Acinetobacter baumannii. Various clinical end points were reported, while microbiological end points were reported in 18 (66.7%) studies. Cefiderocol-related side effects were uncommon and rarely use-limiting. CONCLUSIONS This systematic review depicts relative clinical effectiveness of off-label cefiderocol, most commonly for P. aeruginosa and A. baumannii infections as combination antibiotic therapy. Further study is needed to elucidate the safety and efficacy of cefiderocol across an expanded set of patients and indications.
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Affiliation(s)
- Riyan Babidhan
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Abigale Lewis
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Cailin Atkins
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | | | - Branden D Nemecek
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center - Mercy Hospital, Pittsburgh, Pennsylvania, USA
| | - Courtney A Montepara
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - David E Zimmerman
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Medical Center - Mercy Hospital, Pittsburgh, Pennsylvania, USA
| | - Jordan R Covvey
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
| | - Anthony J Guarascio
- Duquesne University School of Pharmacy, Pittsburgh, Pennsylvania, USA
- Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
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19
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Shahbazi F, Shojaei L, Farvadi F, Kadivarian S. Antimicrobial safety considerations in critically ill patients: part I: focused on acute kidney injury. Expert Rev Clin Pharmacol 2022; 15:551-561. [PMID: 35734940 DOI: 10.1080/17512433.2022.2093713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Antibiotic prescription is a challenging issue in critical care settings. Different pharmacokinetic and pharmacodynamic properties, polypharmacy, drug interactions, and high incidence of multidrug-resistant microorganisms in this population can influence the selection, safety, and efficacy of prescribed antibiotics. AREAS COVERED In the current article, we searched PubMed, Scopus, and Google Scholar for estimating renal function in acute kidney injury, nephrotoxicity of commonly used antibiotics, and nephrotoxin stewardship in intensive care units. EXPERT OPINION Early estimation of kidney function with an accurate method may be helpful to optimize antimicrobial treatment in critically ill patients. Different antibiotic dosing regimens may be required for patients with acute kidney injury. In many low-resource settings, therapeutic drug monitoring is not available for antibiotics. Acute kidney injury may influence treatment effectiveness and patient outcome.
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Affiliation(s)
- Foroud Shahbazi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Lida Shojaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fakhrossadat Farvadi
- Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Kadivarian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
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20
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Gras J, Villar-Fernandez S, Baylac P, Xhaard A, Valade S, Camelena F, Bercot B, Touratier S, de Fontbrune FS, Molina JM, Lafaurie M. Successful cefiderocol therapy of severe infections due to difficult-to-treat Pseudomonas aeruginosa in two allogeneic hematopoietic stem cell transplantation recipients. Ann Hematol 2022; 101:1365-1367. [PMID: 35039899 DOI: 10.1007/s00277-021-04737-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Julien Gras
- Infectious Diseases Department, APHP-Saint Louis Hospital, Paris, France.
- U944 INSERM, CNRS UMR 7212 "Biology of Emerging Viruses" Team, Institut de Recherche Saint Louis, Université de Paris, APHP-Saint Louis Hospital, Paris, France.
| | - Sara Villar-Fernandez
- Hematology Department and Bone Marrow Transplantation Unit, APHP-Saint Louis Hospital, Paris, France
| | - Pierre Baylac
- Hematology Department and Bone Marrow Transplantation Unit, APHP-Saint Louis Hospital, Paris, France
| | - Aliénor Xhaard
- Hematology Department and Bone Marrow Transplantation Unit, APHP-Saint Louis Hospital, Paris, France
| | - Sandrine Valade
- Intensive Care Unit Department, APHP-Saint Louis Hospital, Paris, France
| | | | - Béatrice Bercot
- Microbiology Department, APHP-Saint Louis Hospital, Paris, France
| | - Sophie Touratier
- Pharmacology Department, APHP-Saint Louis Hospital, Paris, France
| | - Flore Sicre de Fontbrune
- Hematology Department and Bone Marrow Transplantation Unit, APHP-Saint Louis Hospital, Paris, France
| | - Jean-Michel Molina
- Infectious Diseases Department, APHP-Saint Louis Hospital, Paris, France
- U944 INSERM, CNRS UMR 7212 "Biology of Emerging Viruses" Team, Institut de Recherche Saint Louis, Université de Paris, APHP-Saint Louis Hospital, Paris, France
| | - Matthieu Lafaurie
- Infectious Diseases Department, APHP-Saint Louis Hospital, Paris, France
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21
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Losito AR, Raffaelli F, Del Giacomo P, Tumbarello M. New Drugs for the Treatment of Pseudomonas aeruginosa Infections with Limited Treatment Options: A Narrative Review. Antibiotics (Basel) 2022; 11:antibiotics11050579. [PMID: 35625223 PMCID: PMC9137685 DOI: 10.3390/antibiotics11050579] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 12/13/2022] Open
Abstract
P. aeruginosa is still one of the most threatening pathogens responsible for serious hospital-acquired infections. It is intrinsically resistant to many antimicrobial agents and additional acquired resistance further complicates the management of such infections. High rates of combined antimicrobial resistance persist in many countries, especially in the eastern and south-eastern parts of Europe. The aim of this narrative review is to provide a comprehensive assessment of the epidemiology, latest data, and clinical evidence on the current and new available drugs active against P. aeruginosa isolates with limited treatment options. The latest evidence and recommendations supporting the use of ceftolozane-tazobactam and ceftazidime-avibactam, characterized by targeted clinical activity against a significant proportion of P. aeruginosa strains with limited treatment options, are described based on a review of the latest microbiological and clinical studies. Cefiderocol, with excellent in vitro activity against P. aeruginosa isolates, good stability to all β-lactamases and against porin and efflux pumps mutations, is also examined. New carbapenem combinations are explored, reviewing the latest experimental and initial clinical evidence. One section is devoted to a review of new anti-pseudomonal antibiotics in the pipeline, such as cefepime-taniborbactam and cefepime-zidebactam. Finally, other “old” antimicrobials, mainly fosfomycin, that can be used as combination strategies, are described.
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Affiliation(s)
- Angela Raffaella Losito
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.R.L.); (F.R.); (P.D.G.)
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.R.L.); (F.R.); (P.D.G.)
| | - Paola Del Giacomo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.R.L.); (F.R.); (P.D.G.)
| | - Mario Tumbarello
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, 53100 Siena, Italy
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Senese, 53100 Siena, Italy
- Correspondence: or ; Tel.: +39-0577-586572
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22
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Wang C, Yang D, Wang Y, Ni W. Cefiderocol for the Treatment of Multidrug-Resistant Gram-Negative Bacteria: A Systematic Review of Currently Available Evidence. Front Pharmacol 2022; 13:896971. [PMID: 35496290 PMCID: PMC9039133 DOI: 10.3389/fphar.2022.896971] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Cefiderocol is a novel synthetic siderophore-conjugated antibiotic that hijacks the bacterial iron transport systems facilitating drug entry into cells, achieving high periplasmic concentrations. This systematic review analyzed the currently available literature on cefiderocol. It summarized in vitro susceptibility data, in vivo antimicrobial activity, pharmacokinetics/pharmacodynamics (PK/PD), clinical efficacy, safety and resistance mechanisms of cefiderocol. Cefiderocol has potent in vitro and in vivo activity against multidrug-resistant (MDR) Gram-negative bacteria, including carbapenem-resistant isolates. But New Delhi Metallo-β-lactamase (NDM)- positive isolates showed significantly higher MICs than other carbapenemase-producing Enterobacterales, with a susceptible rate of 83.4% for cefiderocol. Cefiderocol is well-tolerated, and the PK/PD target values can be achieved using a standard dose regimen or adjusted doses according to renal function. Clinical trials demonstrated that cefiderocol was non-inferiority to the comparator drugs in treating complicated urinary tract infection and nosocomial pneumonia. Case reports and series showed that cefiderocol was a promising therapeutic agent in carbapenem-resistant infections. However, resistant isolates and reduced susceptibility during treatment to cefiderocol have already been reported. In conclusion, cefiderocol is a promising powerful weapon for treating MDR recalcitrant infections.
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Affiliation(s)
- Chuanhai Wang
- Department of Pulmonary and Critical Care Medicine, Shengli Oilfield Central Hospital, Dongying, China
| | - Deqing Yang
- Department of Pharmacy, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yifan Wang
- Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital, Beijing, China
| | - Wentao Ni
- Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital, Beijing, China
- *Correspondence: Wentao Ni,
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23
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Ong’uti S, Czech M, Robilotti E, Holubar M. Cefiderocol: A New Cephalosporin Stratagem Against Multidrug-Resistant Gram-Negative Bacteria. Clin Infect Dis 2022; 74:1303-1312. [PMID: 34492098 PMCID: PMC9989360 DOI: 10.1093/cid/ciab757] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Indexed: 01/19/2023] Open
Abstract
Cefiderocol is a novel injectable siderophore cephalosporin that hijacks the bacterial iron transport machinery to facilitate cell entry and achieve high periplasmic concentrations. It has broad in vitro activity against gram-negative bacteria, including multidrug-resistant (MDR) organisms such as carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa, and Acinetobacter baumannii. It was approved by the US Food and Drug Administration for the treatment of complicated urinary tract infections and nosocomial pneumonia based on clinical trials that demonstrated noninferiority to comparators. In this review, we summarize the available in vitro and clinical data, including recent evidence from 2 phase 3 clinical trials (APEKS-NP and CREDIBLE-CR), and discuss the place of cefiderocol in the clinician's armamentarium against MDR gram-negative infections.
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Affiliation(s)
- Sharon Ong’uti
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mary Czech
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Marisa Holubar
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
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24
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Rose L, Lai L, Byrne D. Successful prolonged treatment of a carbapenem-resistant Acinetobacter baumannii hip infection with cefiderocol: A case report. Pharmacotherapy 2022; 42:268-271. [PMID: 35075683 DOI: 10.1002/phar.2660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022]
Abstract
We report a 50-year-old Caucasian male with a complicated past medical history who developed extensive polymicrobial osteomyelitis, including a carbapenem-resistant Acinetobacter baumannii (CRAB). In order to streamline therapy, the patient received compassionate use cefiderocol for 6 weeks which was well tolerated. In addition, the patient's infection was considered cured at end of treatment. Few cases on the use of prolonged cefiderocol for treatment of osteomyelitis due to CRAB have been published. Our patient did not report adverse reactions, nor did he develop laboratory abnormalities which were assessed throughout and at the end of the 6-week course.
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Affiliation(s)
- Lucia Rose
- Department of Pharmacy, Cooper University Hospital, Camden, New Jersey, USA
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Lauren Lai
- Division of Infectious Disease, Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Dana Byrne
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
- Division of Infectious Disease, Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
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25
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Antimicrobial Treatment Options for Difficult-to-Treat Resistant Gram-Negative Bacteria Causing Cystitis, Pyelonephritis, and Prostatitis: A Narrative Review. Drugs 2022; 82:407-438. [PMID: 35286622 PMCID: PMC9057390 DOI: 10.1007/s40265-022-01676-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 02/06/2023]
Abstract
Urinary tract infections, including cystitis, acute pyelonephritis, and prostatitis, are among the most common diagnoses prompting antibiotic prescribing. The rise in antimicrobial resistance over the past decades has led to the increasing challenge of urinary tract infections because of multidrug-resistant and "difficult-to-treat resistance" among Gram-negative bacteria. Recent advances in pharmacotherapy and medical microbiology are modernizing how these urinary tract infections are treated. Advances in pharmacotherapy have included not only the development and approval of novel antibiotics, such as ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam, ceftolozane/tazobactam, cefiderocol, plazomicin, and glycylcyclines, but also the re-examination of the potential role of legacy antibiotics, including older aminoglycosides and tetracyclines. Recent advances in medical microbiology allow phenotypic and molecular mechanism of resistance testing, and thus antibiotic prescribing can be tailored to the mechanism of resistance in the infecting pathogen. Here, we provide a narrative review on the clinical and pre-clinical studies of drugs that can be used for difficult-to-treat resistant Gram-negative bacteria, with a particular focus on data relevant to the urinary tract. We also offer a pragmatic framework for antibiotic selection when encountering urinary tract infections due to difficult-to-treat resistant Gram-negative bacteria based on the organism and its mechanism of resistance.
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26
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Fariñas MC. Clinical experience of cefiderocol. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35 Suppl 2:35-38. [PMID: 36193983 PMCID: PMC9632058 DOI: 10.37201/req/s02.05.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Infections by antibiotic-resistant microorganisms could be considered a "stealth pandemic" that we fight daily in most hospitals. Some estimates suggest that today 700,000 deaths per year can be attributed to antimicrobial resistance. By the year 2050, it is estimated that this will increase to ten million deaths per year as a result of infections by multidrug-resistant microorganisms. In this context, the availability of antimicrobial therapy that is effective against these pathogens is essential to be able to "save the lives" of our patients. Cefiderocol, a new cephalosporin with a different mechanism of action, will be an essential treatment in many infections caused by resistant aerobic gram-negative bacteria. Cefiderocol has been used to treat patients with complicated urinary tract infections (cUTI); hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HAP); in patients with sepsis and bacteremia, some without an identified primary focus of infection.
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Affiliation(s)
- María Carmen Fariñas
- Correspondence: María Carmen Fariñas Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla. Universidad de Cantabria. Santander. Cantabria, Spain. E-mail:
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27
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Gatti M, Viaggi B, Rossolini GM, Pea F, Viale P. An Evidence-Based Multidisciplinary Approach Focused on Creating Algorithms for Targeted Therapy of Infection-Related Ventilator-Associated Complications (IVACs) Caused by Pseudomonas aeruginosa and Acinetobacter baumannii in Critically Ill Adult Patients. Antibiotics (Basel) 2021; 11:antibiotics11010033. [PMID: 35052910 PMCID: PMC8773303 DOI: 10.3390/antibiotics11010033] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Background: To develop evidence-based algorithms for targeted antibiotic therapy of infection-related ventilator-associated complications (IVACs) caused by non-fermenting Gram-negative pathogens. (2) Methods: A multidisciplinary team of four experts had several rounds of assessments for developing algorithms devoted to targeted antimicrobial therapy of IVACs caused by two non-fermenting Gram-negative pathogens. A literature search was performed on PubMed-MEDLINE (until September 2021) to provide evidence for supporting therapeutic choices. Quality and strength of evidence was established according to a hierarchical scale of the study design. Six different algorithms with associated recommendations in terms of therapeutic choice and dosing optimization were suggested according to the susceptibility pattern of two non-fermenting Gram-negative pathogens: multi-susceptible Pseudomonas aeruginosa (PA), multidrug-resistant (MDR) metallo-beta-lactamase (MBL)-negative-PA, MBL-positive-PA, carbapenem-susceptible Acinetobacter baumannii (AB), and carbapenem-resistant AB. (3) Results: Piperacillin–tazobactam or fourth-generation cephalosporins represent the first therapeutic choice in IVACs caused by multi-susceptible PA. A carbapenem-sparing approach favouring the administration of novel beta-lactam/beta-lactamase inhibitors should be pursued in the management of MDR-MBL-negative PA infections. Cefiderocol should be used as first-line therapy for the management of IVACs caused by MBL-producing-PA or carbapenem-resistant AB. Fosfomycin-based combination therapy, as well as inhaled colistin, could be considered as a reasonable alternative for the management of IVACs due to MDR-PA and carbapenem-resistant AB. (4) Conclusions: The implementation of algorithms focused on prompt revision of antibiotic regimens guided by results of conventional and rapid diagnostic methodologies, appropriate place in therapy of novel beta-lactams, implementation of strategies for sparing the broadest-spectrum antibiotics, and pharmacokinetic/pharmacodynamic optimization of antibiotic dosing regimens is strongly suggested.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.G.); (P.V.)
- SSD Clinical Pharmacology, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Bruno Viaggi
- Neurointensive Care Unit, Department of Anesthesiology, Careggi University Hospital, 50134 Florence, Italy;
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
- Microbiology and Virology Unit, Florence Careggi University Hospital, 50134 Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.G.); (P.V.)
- SSD Clinical Pharmacology, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Correspondence:
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy; (M.G.); (P.V.)
- Infectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
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Rando E, Segala FV, Vargas J, Seguiti C, De Pascale G, Murri R, Fantoni M. Cefiderocol for Severe Carbapenem-Resistant A. baumannii Pneumonia: Towards the Comprehension of Its Place in Therapy. Antibiotics (Basel) 2021; 11:antibiotics11010003. [PMID: 35052880 PMCID: PMC8773286 DOI: 10.3390/antibiotics11010003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Cefiderocol use in A. baumannii pneumonia still represents an important matter of debate. The aim of this study is to describe 13 cases of carbapenem-resistant A. baumannii (CRAB) pneumonia treated with cefiderocol in real-life practice. We retrospectively included patients with CRAB pneumonia hospitalized at Fondazione Policlinico Universitario Agostino Gemelli Hospital treated with cefiderocol either in the general ward or the intensive care unit. A total of 11 patients out of 13 had ventilator-associated pneumonia caused by CRAB, and 12/13 patients had polymicrobial infection. We found a 30-day success rate of 54%. Cefiderocol may have a role when facing severe XDR A. baumannii pneumonia. Future studies are warranted to better define its place in therapy in CRAB infections.
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Affiliation(s)
- Emanuele Rando
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.V.S.); (C.S.); (R.M.); (M.F.)
- Correspondence:
| | - Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.V.S.); (C.S.); (R.M.); (M.F.)
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Joel Vargas
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (J.V.); (G.D.P.)
| | - Cristina Seguiti
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.V.S.); (C.S.); (R.M.); (M.F.)
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gennaro De Pascale
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (J.V.); (G.D.P.)
| | - Rita Murri
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.V.S.); (C.S.); (R.M.); (M.F.)
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Massimo Fantoni
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.V.S.); (C.S.); (R.M.); (M.F.)
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Streling AP, Al Obaidi MM, Lainhart WD, Zangeneh T, Khan A, Dinh AQ, Hanson B, Arias CA, Miller WR. Evolution of Cefiderocol Non-Susceptibility in Pseudomonas aeruginosa in a Patient Without Previous Exposure to the Antibiotic. Clin Infect Dis 2021; 73:e4472-e4474. [PMID: 33411899 PMCID: PMC8825772 DOI: 10.1093/cid/ciaa1909] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
We report the emergence of non-susceptibility to cefiderocol from a subpopulation of Pseudomonas aeruginosa recovered from a patient without history of cefiderocol exposure. Whole genome sequencing identified mutations in major iron transport pathways previously associated with cefiderocol uptake. Susceptibility testing should be performed before therapy with siderophore cephalosporins.
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Affiliation(s)
- Ana Paula Streling
- Center for Antimicrobial Resistance and Microbial Genomics, UTHealth McGovern School of Medicine, Houston, Texas, USA
- Universidade Federal de São Paulo - UNIFESP, Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine. Escola Paulista de Medicina–EPM, São Paulo–SP, Brazil
| | - Mohanad M Al Obaidi
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - William D Lainhart
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Pathology, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Tirdad Zangeneh
- Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Ayesha Khan
- Center for Antimicrobial Resistance and Microbial Genomics, UTHealth McGovern School of Medicine, Houston, Texas, USA
- Department of Microbiology and Molecular Genetics, UTHealth McGovern School of Medicine, Houston, Texas, USA
- MD Anderson Cancer Center and UT Health Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - An Q Dinh
- Center for Antimicrobial Resistance and Microbial Genomics, UTHealth McGovern School of Medicine, Houston, Texas, USA
- Division of Infectious Diseases, UTHealth McGovern School of Medicine, Houston, TX, USA
- Center for Infectious Diseases, UTHealth, School of Public Health, Houston, TX, USA
| | - Blake Hanson
- Center for Antimicrobial Resistance and Microbial Genomics, UTHealth McGovern School of Medicine, Houston, Texas, USA
- Division of Infectious Diseases, UTHealth McGovern School of Medicine, Houston, TX, USA
- Center for Infectious Diseases, UTHealth, School of Public Health, Houston, TX, USA
| | - Cesar A Arias
- Center for Antimicrobial Resistance and Microbial Genomics, UTHealth McGovern School of Medicine, Houston, Texas, USA
- MD Anderson Cancer Center and UT Health Graduate School of Biomedical Sciences, Houston, Texas, USA
- Division of Infectious Diseases, UTHealth McGovern School of Medicine, Houston, TX, USA
- Center for Infectious Diseases, UTHealth, School of Public Health, Houston, TX, USA
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia
| | - William R Miller
- Center for Antimicrobial Resistance and Microbial Genomics, UTHealth McGovern School of Medicine, Houston, Texas, USA
- Division of Infectious Diseases, UTHealth McGovern School of Medicine, Houston, TX, USA
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30
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Pascale R, Pasquini Z, Bartoletti M, Caiazzo L, Fornaro G, Bussini L, Volpato F, Marchionni E, Rinaldi M, Trapani F, Temperoni C, Gaibani P, Ambretti S, Barchiesi F, Viale P, Giannella M. Cefiderocol treatment for carbapenem-resistant Acinetobacter baumannii infection in the ICU during the COVID-19 pandemic: a multicentre cohort study. JAC Antimicrob Resist 2021; 3:dlab174. [PMID: 34806011 PMCID: PMC8599913 DOI: 10.1093/jacamr/dlab174] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
Objectives To analyse the impact of cefiderocol use on outcome in patients admitted to the ICU for severe COVID-19 and further diagnosed with carbapenem-resistant Acinetobacter baumannii (CR-Ab) infection. Methods Retrospective multicentre observational study was performed at four Italian hospitals, from January 2020 to April 2021. Adult patients admitted to ICU for severe COVID-19 and further diagnosed with CR-Ab infections were enrolled. Patients treated with cefiderocol, as compassionate use, for at least 72 h were compared with those receiving alternative regimens. Primary endpoint was all-cause 28 day mortality. The impact of cefiderocol on mortality was evaluated by multivariable Cox regression model. Results In total, 107 patients were enrolled (76% male, median age 65 years). The median time from ICU admission to CR-Ab infection diagnosis was 14 (IQR 8–20) days, and the main types of CR-Ab infections were bloodstream infection (58%) and lower respiratory tract infection (41%). Cefiderocol was administered to 42 patients within a median of 2 (IQR 1–4) days after CR-Ab infection diagnosis and as monotherapy in all cases. The remaining patients received colistin, mostly (82%) administered as combination therapy. All-cause 28 day mortality rate was 57%, without differences between groups (cefiderocol 55% versus colistin 58% P = 0.70). In multivariable analysis, the independent risk factor for mortality was SOFA score (HR 1.24, 95% CI 1.15–1.38, P < 0.001). Cefiderocol was associated with a non-significant lower mortality risk (HR 0.64, 95% CI 0.38–1.08, P = 0.10). Conclusions Our study confirms the potential role of cefiderocol in the treatment of CR-Ab infection, but larger clinical studies are needed.
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Affiliation(s)
- Renato Pascale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Zeno Pasquini
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Luca Caiazzo
- Infectious Disease Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Giacomo Fornaro
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Linda Bussini
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Francesca Volpato
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Elisa Marchionni
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Matteo Rinaldi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Filippo Trapani
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Chiara Temperoni
- Infectious Disease Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Paolo Gaibani
- Operative Unit of Microbiology, University of Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Simone Ambretti
- Operative Unit of Microbiology, University of Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Francesco Barchiesi
- Infectious Disease Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy.,Department of Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
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31
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Cipko K, Kizny Gordon A, Adhikari S, Konecny P. Cefiderocol treatment of Pseudomonas aeruginosa and extensively drug-resistant Acinetobacter baumannii retained spinal hardware infection causing reversible acute interstitial nephritis: Recto: Cefiderocol causing acute interstitial nephritis. Int J Infect Dis 2021; 109:108-111. [PMID: 34157388 DOI: 10.1016/j.ijid.2021.06.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022] Open
Abstract
Infections with extensively drug-resistant Acinetobacter baumannii (XDRAB) have limited therapeutic options. We report successful salvage treatment of XDRAB and Pseudomonas aeruginosa-infected retained spinal hardware with cefiderocol, despite the development of reversible acute interstitial nephritis after 32 days of treatment.
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Affiliation(s)
- Kimberly Cipko
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Sydney, New South Wales, Australia; Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.
| | - Alice Kizny Gordon
- Department of Microbiology, New South Wales Health Pathology, St George Hospital, New South Wales, Australia; St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Suman Adhikari
- St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Pharmacy, St George Hospital, Sydney, New South Wales, Australia
| | - Pamela Konecny
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Sydney, New South Wales, Australia; St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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32
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McCreary EK, Heil EL, Tamma PD. New Perspectives on Antimicrobial Agents: Cefiderocol. Antimicrob Agents Chemother 2021; 65:e0217120. [PMID: 34031052 PMCID: PMC8373209 DOI: 10.1128/aac.02171-20] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Bacterial resistance to carbapenem agents has reached alarming levels. Accordingly, collaborative efforts between national and international organizations and the pharmaceutical industry have led to an impressive expansion of commercially available β-lactam agents in recent years. No available agent comes close to the broad range of activity afforded by cefiderocol, a novel siderophore-cephalosporin conjugate. The novelty of and need for cefiderocol are clear, but available clinical data are conflicting, leaving infectious diseases specialists puzzled as to when to prescribe this agent in clinical practice. After a brief overview of cefiderocol pharmacokinetics and pharmacodynamics, safety data, cefiderocol susceptibility testing, and putative mechanisms of cefiderocol resistance, this review focuses on determining cefiderocol's role in the management of specific pathogens, including carbapenem-resistant Acinetobacter baumannii complex, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Enterobacterales, and less commonly identified glucose-nonfermenting organisms such as Stenotrophomonas maltophilia, Burkholderia species, and Achromobacter species. Available preclinical, clinical trial, and postmarketing data are summarized for each organism, and each section concludes with our opinions on where to position cefiderocol as a clinical therapeutic.
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Affiliation(s)
- Erin K. McCreary
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Emily L. Heil
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Pranita D. Tamma
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Baltimore, Maryland, USA
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33
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Chahine EB, Dougherty JA, Thornby KA, Guirguis EH. Antibiotic Approvals in the Last Decade: Are We Keeping Up With Resistance? Ann Pharmacother 2021; 56:441-462. [PMID: 34259076 DOI: 10.1177/10600280211031390] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To review the spectrum of activity, efficacy, safety, and role in therapy of all antibiotics and related biologics approved by the Food and Drug Administration (FDA) in the last decade. DATA SOURCES A literature search was performed using PubMed and Google Scholar (2010 to end May 2021) with the search terms' name of the antibiotic or the biologic. Data were also obtained from the prescribing information, FDA, and ClinicalTrials.gov websites. STUDY SELECTION All relevant English-language, late phase clinical trials assessing the safety and efficacy of the identified drugs were included. Review articles and references of retrieved articles were evaluated for relevant data. DATA SYNTHESIS Antibiotic resistance is a public health crisis, and antibiotic development is imperative to outpace the ability of bacteria to develop resistance. Only 17 new systemic antibiotics and 1 related biologic have been approved by the FDA since 2010. Among these drugs, 14 were approved for common bacterial infections, 1 was approved for Clostridioides difficile infection (CDI), 1 was licensed to prevent CDI recurrence, and 2 were approved for drug-resistant tuberculosis. Very few antibiotics are in clinical development. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE The arrival of these new antibiotics was welcomed with great enthusiasm, particularly when they met previously unmet medical needs. Unfortunately, the majority of them represent modifications to existing chemical structures rather than new drug classes. Despite the availability of these antibiotics, managing patients with deep-seated infections and those with extensively resistant gram-negative organisms remains challenging. CONCLUSIONS The number of new antibiotics and their indications are not keeping up with resistance and the needs of the patients.
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Affiliation(s)
- Elias B Chahine
- Palm Beach Atlantic University Gregory School of Pharmacy, FL, USA
| | - John A Dougherty
- Palm Beach Atlantic University Gregory School of Pharmacy, FL, USA
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34
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Jorda A, Zeitlinger M. Pharmacological and clinical profile of cefiderocol, a siderophore cephalosporin against gram-negative pathogens. Expert Rev Clin Pharmacol 2021; 14:777-791. [PMID: 33849355 DOI: 10.1080/17512433.2021.1917375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Introduction: Increasing resistance of gram-negative bacteria poses a serious threat to global health. Thus, efficacious and safe antibiotics against resistant pathogens are urgently needed. Cefiderocol, a siderophore cephalosporin, addresses this unmet need.Areas covered: For this article, we screened all preclinical and clinical studies on cefiderocol published by January 2021 on PubMed. Also, regulatory documents, recent conference contributions, and selected data of antibiotic competitors are reviewed. We provide a comprehensive overview of the mode of action, in vitro and in vivo activity, pharmacokinetics/pharmacodynamics, and human pharmacokinetics. Last, we discuss the efficacy and safety data from the pivotal trials.Expert opinion: Cefiderocol was in vitro potent against virtually all gram-negative pathogens and resistance was rare. The target site pharmacokinetics (i.e. urinary and lung penetration) have been well described in humans and important PK/PD targets were reached. In the clinical trials, cefiderocol was non-inferior to carbapenems in the treatment of complicated urinary tract infections and nosocomial pneumonia. Against carbapenem-resistant gram-negative pathogens, cefiderocol was similar to the best available therapy, which was mainly based on the backbone agent colistin. Overall, a substantial body of evidence supports the clinical use of cefiderocol in patients with gram-negative infections and limited treatment options.
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Affiliation(s)
- Anselm Jorda
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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35
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Mabayoje DA, NicFhogartaigh C, Cherian BP, Tan MGM, Wareham DW. Compassionate use of cefiderocol for carbapenem-resistant Acinetobacter baumannii prosthetic joint infection. JAC Antimicrob Resist 2021; 3:i21-i24. [PMID: 34223152 PMCID: PMC8251250 DOI: 10.1093/jacamr/dlab055] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Cefiderocol is a recently licensed novel siderophore-conjugated cephalosporin stable to hydrolysis by serine and MBLs. It has been successfully used to treat Enterobacterales infections and is approved for the treatment of infections due to aerobic Gram-negative organisms in adults with limited treatment options. Objectives To describe the compassionate use of cefiderocol and clinical outcome in a case of prosthetic joint infection due to MDR Acinetobacter baumannii. Patients and methods This case study follows a 66-year-old woman who sustained an open fracture of the left distal humerus in Pakistan. She underwent open reduction and internal fixation and on return to the UK presented to hospital with a discharging surgical wound. Results Debridement of her wound cultured NDM carbapenemase-producing A. baumannii susceptible to colistin, tobramycin and tigecycline only. She developed vomiting with acute kidney injury with colistin and tigecycline. Antimicrobial efficacy of cefiderocol was predicted from in vitro and in vivo susceptibility tests. A successful request was made to Shionogi for compassionate use of cefiderocol, which was added to tigecycline. Cefiderocol was well tolerated with no toxicity and improved renal function. In total she received 25 days of cefiderocol and continued on tigecycline for a further 6 weeks in the community. She has well-healed wounds and good range of elbow movement. Conclusions Cefiderocol’s novel mode of cell entry is effective against MDR Gram-negative bacteria with reduced toxicity compared with other last line antibiotics. Our case demonstrates that cefiderocol may be useful as therapy for patients with limited treatment options due to antimicrobial resistance. The prescribing information for cefiderocol is available at: https://shionogi-eu-content.com/gb/fetcroja/pi.
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Affiliation(s)
| | | | | | - Mei Gie Meiqi Tan
- Antimicrobial Research Group, Blizard Institute, Queen Mary University of London, London, UK
| | - David W Wareham
- Division of Infection, Barts Health NHS Trust, London, UK.,Antimicrobial Research Group, Blizard Institute, Queen Mary University of London, London, UK
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36
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Falcone M, Tiseo G, Nicastro M, Leonildi A, Vecchione A, Casella C, Forfori F, Malacarne P, Guarracino F, Barnini S, Menichetti F. Cefiderocol as Rescue Therapy for Acinetobacter baumannii and Other Carbapenem-resistant Gram-negative Infections in Intensive Care Unit Patients. Clin Infect Dis 2021; 72:2021-2024. [PMID: 32941593 DOI: 10.1093/cid/ciaa1410] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022] Open
Abstract
Ten critically ill patients with either bacteremia or ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii, Stenotrophomonas maltophilia, or New Delhi metallo-β-lactamase-producing Klebsiella pneumoniae received cefiderocol. All strains had minimum inhibitory concentration ≤2 μg/mL. Thirty-day clinical success and survival rates were 70% and 90%, respectively. Two patients had a microbiological failure. Future prospective studies are warranted.
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Affiliation(s)
- Marco Falcone
- Infectious Diseases Azienda Ospedaliera Universitaria Pisana Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giusy Tiseo
- Infectious Diseases Azienda Ospedaliera Universitaria Pisana Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Manuela Nicastro
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | - Costanza Casella
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Francesco Forfori
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Paolo Malacarne
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Fabio Guarracino
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Simona Barnini
- Microbiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Francesco Menichetti
- Infectious Diseases Azienda Ospedaliera Universitaria Pisana Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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37
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Bavaro DF, Belati A, Diella L, Stufano M, Romanelli F, Scalone L, Stolfa S, Ronga L, Maurmo L, Dell’Aera M, Mosca A, Dalfino L, Grasso S, Saracino A. Cefiderocol-Based Combination Therapy for "Difficult-to-Treat" Gram-Negative Severe Infections: Real-Life Case Series and Future Perspectives. Antibiotics (Basel) 2021; 10:antibiotics10060652. [PMID: 34072342 PMCID: PMC8227820 DOI: 10.3390/antibiotics10060652] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
Cefiderocol is a new cephalosporin displaying against extensively resistant (XDR) Gram-negative bacteria. We report our experience with cefiderocol-based combination therapies as “rescue” treatments in immunocompromised or critically ill patients or in patients with post-surgical infections who had failed previous regimens. A total of 13 patients were treated from 1 September 2020 to 31 March 2021. In total, 5/13 (38%) patients were classified as critically ill, due to severe COVID-19 lung failure; 4/13 (31%) patients had post-surgical infections and 4/13 (31%) had severe infections in immunocompromised subjects due to solid organ transplantation (2/4) or hematological malignancy (2/4). Overall, 10/13 infections were caused by carbapenem-resistant Acinetobacter baumannii, one by KPC-positive ceftazidime/avibactam-resistant Klebsiella pneumonia and two by Pseudomonas aeruginosa XDR. Based on clinical, microbiological and hematobiochemical evaluation, cefiderocol was associated with different companion drugs, particularly with fosfomycin, high-dose tigecycline and/or colistin. Microbiological eradication was achieved in all cases and the 30-day survival rate was 10/13; two patients died due to SARS-CoV-2 lung failure, whereas one death was attributed to subsequent infections. No recurrent infections within 30 days were reported. Finally, we hereby discuss the therapeutic potential of cefiderocol and the possible place in the therapy of this novel drug.
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Affiliation(s)
- Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
- Correspondence:
| | - Alessandra Belati
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
| | - Lucia Diella
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
| | - Monica Stufano
- Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.S.); (L.D.); (S.G.)
| | - Federica Romanelli
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Luca Scalone
- Segreteria Scientifica Comitato Etico Area 2, University of Bari, 70124 Bari, Italy; (L.S.); (L.M.)
| | - Stefania Stolfa
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Luigi Ronga
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Leonarda Maurmo
- Segreteria Scientifica Comitato Etico Area 2, University of Bari, 70124 Bari, Italy; (L.S.); (L.M.)
| | - Maria Dell’Aera
- Direttore Farmacia Ospedaliera AOU Policlinico di Bari, University of Bari, 70124 Bari, Italy;
| | - Adriana Mosca
- Section of Microbiology and Virology, University of Bari, 70124 Bari, Italy; (F.R.); (S.S.); (L.R.); (A.M.)
| | - Lidia Dalfino
- Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.S.); (L.D.); (S.G.)
| | - Salvatore Grasso
- Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.S.); (L.D.); (S.G.)
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.B.); (L.D.); (A.S.)
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38
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Bavaro DF, Romanelli F, Stolfa S, Belati A, Diella L, Ronga L, Fico C, Monno L, Mosca A, Saracino A. Recurrent neurosurgical site infection by extensively drug-resistant P. aeruginosa treated with cefiderocol: a case report and literature review. Infect Dis (Lond) 2021; 53:206-211. [PMID: 33295821 DOI: 10.1080/23744235.2020.1856921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Cefiderocol is a new siderophore cephalosporin designed to be active against extensively resistant Gram-negative bacteria; however, clinical studies are limited to complicated urinary tract infections, pneumonia, and intra-abdominal infections. To date, no data are available on neurosurgical site infections. CASE PRESENTATION We present a case of a patient successfully cured with Cefiderocol for a neurosurgical site infection due to extensively resistant P. aeruginosa, who had failed a previous treatment based on combined antimicrobial therapy and right parietal bone excision. CONCLUSIONS Cefiderocol is a promising antibiotic for complicated infections due to multidrug resistant gram-negative bacteria.
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Affiliation(s)
- Davide Fiore Bavaro
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Federica Romanelli
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Stefania Stolfa
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Alessandra Belati
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Lucia Diella
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Luigi Ronga
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Cecilia Fico
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Laura Monno
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Adriana Mosca
- Microbiology and Virology Unit, University of Bari, University Hospital Policlinico, Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy
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Taheri Y, Joković N, Vitorović J, Grundmann O, Maroyi A, Calina D. The Burden of the Serious and Difficult-to-Treat Infections and a New Antibiotic Available: Cefiderocol. Front Pharmacol 2021; 11:578823. [PMID: 33628170 PMCID: PMC7898678 DOI: 10.3389/fphar.2020.578823] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Infection is a disease that can occur due to the entrance of a virus, bacteria, and other infectious agents. Cefiderocol is innovative cephalosporin drug that belongs to a special class of antibiotics, sideromycins, which are taken up by bacterial cells through active transport. The unique cell entry and stability to β-lactamases allow cefiderocol to overcome the most common resistance mechanisms in Gram-negative bacteria. Objective: This article aims to highlight the therapeutic efficacy, safety and tolerability of cefiderocol, with a focus on the FDA label. Methods: The pharmacological properties of cefiderocol are also summarized. In this review, we conducted literature research on the PubMed database using the following keywords: "antimicrobial treatment", "new antibiotic", "cefiderocol", "siderophore cephalosporin"; "multidrug-resistant", "Gram-negative bacilli", "critically ill patients"; "severe bacterial infections". Results: There were identified the most relevant data about the pathophysiology of serious bacterial infections, antibacterial mechanism of action, microbiology, mechanisms of resistance, pharmacokinetic and pharmacodynamic properties of cefiderocol. Conclusion: The results highlighted there appeared to be clinical benefit from cefiderocol in the treatment of infections caused by Gram-negative aerobic microorganisms in adult patients with severe infections and limited treatment options.
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Affiliation(s)
- Yasaman Taheri
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Pharmacology and Toxicology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nataša Joković
- The Faculty of Science and Mathematics, University of Niš, Niš, Serbia
| | - Jelena Vitorović
- The Faculty of Science and Mathematics, University of Niš, Niš, Serbia
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, United States.,Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Alfred Maroyi
- Department of Botany, University of Fort Hare, Alice, South Africa
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Giacobbe DR, Ciacco E, Girmenia C, Pea F, Rossolini GM, Sotgiu G, Tascini C, Tumbarello M, Viale P, Bassetti M. Evaluating Cefiderocol in the Treatment of Multidrug-Resistant Gram-Negative Bacilli: A Review of the Emerging Data. Infect Drug Resist 2020; 13:4697-4711. [PMID: 33402840 PMCID: PMC7778378 DOI: 10.2147/idr.s205309] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022] Open
Abstract
Infections due to multidrug-resistant Gram-negative bacteria (MDR-GNB), especially when carbapenem resistant, have been very difficult to manage in the last fifteen years, owing to the paucity of dependable therapeutic options. Cefiderocol is a siderophore cephalosporin recently approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) that may have the potential to fill some of the remaining gaps in the treatment of MDR-GNB infections. Among others, cefiderocol demonstrated in vitro activity against carbapenem-resistant Acinetobacter baumannii and metallo-β-lactamases producers. Clinical data from both registrative studies and post-marketing experiences are essential to confirm whether these promises from in vitro studies could readily translate into clinical practice, as well as to delineate the precise place in therapy for cefiderocol for the treatment of MDR-GNB in the near future. Because of its unique potential, it is essential to provide both randomized controlled trials (RCT) and real-life data to improve the ability of clinicians to exploit its benefit in both empirical and targeted treatment of MDR-GNB infections. In this narrative review, we discuss the emerging data from pivotal RCT and initial real-life experiences on the use of cefiderocol for the treatment of MDR-GNB infections.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Eugenio Ciacco
- Pharmacy Unit, S. Salvatore Hospital, ASL1 Abruzzo, L'Aquila, Italy
| | - Corrado Girmenia
- Hematology, Dipartimento Medicina Traslazionale e di Precisione, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,University Hospital IRCCS Policlinico Sant'Orsola Bologna, Bologna, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Carlo Tascini
- SOC Malattie Infettive, Azienda Sanitaria Integrata, University of Udine, Udine, Italy
| | - Mario Tumbarello
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,University Hospital IRCCS Policlinico Sant'Orsola Bologna, Bologna, Italy
| | - Matteo Bassetti
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.,Department of Health Sciences, University of Genoa, Genoa, Italy
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Oliva A, Ceccarelli G, De Angelis M, Sacco F, Miele MC, Mastroianni CM, Venditti M. Cefiderocol for compassionate use in the treatment of complicated infections caused by extensively and pan-resistant Acinetobacter baumannii. J Glob Antimicrob Resist 2020; 23:292-296. [PMID: 33065329 DOI: 10.1016/j.jgar.2020.09.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/11/2020] [Accepted: 09/25/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study presents real-life experience with cefiderocol used on a compassionate basis for treatment of three patients with severe infections caused by extensively/pan-drug resistant (XDR/PDR) Acinetobacter baumannii (Ab). METHODS Serum bactericidal activity was determined and considered as a surrogate of cefiderocol susceptibility. RESULTS Clinical improvement and microbiological eradication of A. baumannii were observed in all three patients, who were affected by extremely complex conditions either for type of infection, adverse effect or resistance profile of A. baumannii. CONCLUSION Cefiderocol for XDR/PDR-Ab infections might be reconsidered, especially in light of the recent disappointing results of the CREDIBLE-CR study.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | | | - Federica Sacco
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Maria Claudia Miele
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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Abdul-Mutakabbir JC, Alosaimy S, Morrisette T, Kebriaei R, Rybak MJ. Cefiderocol: A Novel Siderophore Cephalosporin against Multidrug-Resistant Gram-Negative Pathogens. Pharmacotherapy 2020; 40:1228-1247. [PMID: 33068441 DOI: 10.1002/phar.2476] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cefiderocol (CFDC), (formerly S-649266), is a novel injectable siderophore cephalosporin developed by Shionogi & Co., Ltd., with potent in vitro activity against Gram-negative pathogens including multidrug-resistant (MDR) Enterobacteriaceae and non-fermenting organisms, such as Pseudomonas aeruginosa, Acinetobacter baumannii, Burkholderia cepacia, and Stenotrophomonas maltophilia. Characterized by its siderophore catechol-moiety, CFDC uses a "trojan-horse approach" to navigate through the bacterial periplasmic space, thus evading various beta-lactam degrading enzymes and other mechanisms of resistance present in Gram-negative bacteria. More specifically in carbapenem-resistant Enterobacteriaceae, CFDC has been shown to have activity against extended spectrum beta-lactamases (ESBLs), such as CTX-type, SHV-type, and TEM-type, as well as the Ambler classes of beta-lactamases, including class A (KPC), class B (NDM, IMP, and VIM), class C (AmpC), and class D (OXA, OXA-24, OXA-48, and OXA-48-like). In addition to the strong activity that CFDC has been shown to have against MDR P. aeruginosa, it has also displayed activity against the OXA-23, OXA-24, and OXA-51, beta-lactamases commonly found in MDR A. baumannii. Cefiderocol was recently approved by the US Food and Drug Administration (FDA) for use in complicated urinary tract infections (cUTI), including pyelonephritis, for use in patients 18 years or older with limited or no alternative options for treatment, and is currently being evaluated in a phase III trial for use in nosocomial pneumonia caused by Gram-negative pathogens. The unique features and enhanced activity of CFDC suggest that it is likely to serve as a viable therapeutic option in the treatment of MDR Gram-negative infections. The purpose of this review is to provide an overview of previously published literature explaining CFDC's pharmacology, pharmacokinetic / pharmacodynamic (PK / PD) properties, microbiologic activity, resistance mechanisms, safety parameters, dosing and administration, clinical data, and potential place in therapy.
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Affiliation(s)
- Jacinda C Abdul-Mutakabbir
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Razieh Kebriaei
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Detroit Receiving Hospital, Detroit, Michigan, USA
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43
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Treatment of Bloodstream Infections Due to Gram-Negative Bacteria with Difficult-to-Treat Resistance. Antibiotics (Basel) 2020; 9:antibiotics9090632. [PMID: 32971809 PMCID: PMC7558339 DOI: 10.3390/antibiotics9090632] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/31/2020] [Accepted: 09/13/2020] [Indexed: 12/19/2022] Open
Abstract
The rising incidence of bloodstream infections (BSI) due to Gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR) has been recognized as a global emergency. The aim of this review is to provide a comprehensive assessment of the mechanisms of antibiotic resistance, epidemiology and treatment options for BSI caused by GNB with DTR, namely extended-spectrum Beta-lactamase-producing Enterobacteriales; carbapenem-resistant Enterobacteriales; DTR Pseudomonas aeruginosa; and DTR Acinetobacter baumannii.
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44
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Siméon S, Dortet L, Bouchand F, Roux AL, Bonnin RA, Duran C, Decousser JW, Bessis S, Davido B, Sorriaux G, Dinh A. Compassionate Use of Cefiderocol to Treat a Case of Prosthetic Joint Infection Due to Extensively Drug-Resistant Enterobacter hormaechei. Microorganisms 2020; 8:microorganisms8081236. [PMID: 32823796 PMCID: PMC7464826 DOI: 10.3390/microorganisms8081236] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 67-year old man with a right knee prosthetic joint infection due to extensively drug-resistant Enterobacter hormaechei. The resistance phenotype was due to the overproduction of the intrinsic cephalosporinase (ACT-5) associated with the production of three acquired β-lactamases (CTX-M-15, TEM-1B and OXA-1), and a putative membrane decreased permeability. He was first treated with colistin-tigecyclin due to adverse drug reactions; treatment was switched to cefiderocol for a 12-week antibiotic duration, with a favorable outcome.
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Affiliation(s)
- Soline Siméon
- Infectious Disease Unit, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France; (S.S.); (C.D.); (S.B.); (B.D.)
| | - Laurent Dortet
- Microbiology laboratory, Bicêtre Hospital, AP-HP, UMR 1184, Team Resist, INSERM, Paris-Saclay University, Faculty of Medicine, French National Reference Center for Antibiotic Resistance: Carbapenemase producing Enterobacteriaceae, 94270 Le Kremlin-Bicêtre, France; (L.D.); (R.A.B.)
| | - Frédérique Bouchand
- Pharmacy, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France;
| | - Anne-Laure Roux
- Microbiology laboratory, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France;
| | - Rémy A. Bonnin
- Microbiology laboratory, Bicêtre Hospital, AP-HP, UMR 1184, Team Resist, INSERM, Paris-Saclay University, Faculty of Medicine, French National Reference Center for Antibiotic Resistance: Carbapenemase producing Enterobacteriaceae, 94270 Le Kremlin-Bicêtre, France; (L.D.); (R.A.B.)
| | - Clara Duran
- Infectious Disease Unit, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France; (S.S.); (C.D.); (S.B.); (B.D.)
| | - Jean-Winoc Decousser
- Department of Bacteriology and Infection Control, Henri Mondor University Hospital, AP-HP, 94000 Créteil, France;
- EA 7380 Dynamyc, University Paris-Est Créteil (UPEC), Ecole nationale vétérinaire d’Alfort (EnvA), Faculty of Medecine, 94000 Créteil, France
| | - Simon Bessis
- Infectious Disease Unit, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France; (S.S.); (C.D.); (S.B.); (B.D.)
| | - Benjamin Davido
- Infectious Disease Unit, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France; (S.S.); (C.D.); (S.B.); (B.D.)
| | | | - Aurélien Dinh
- Infectious Disease Unit, Raymond-Poincaré Hospital, AP-HP, Paris Saclay University, 92380 Garches, France; (S.S.); (C.D.); (S.B.); (B.D.)
- Correspondence:
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