Outcomes in patients with thermal injury treated with cefiderocol

Abstract

Gram-negative infections in burn patients remain a challenge due to increasing antibiotic breakpoints and developing resistance of Pseudomonas species, Enterobacter species, and Stenotrophomonas maltophilia. Unfortunately, established breakpoints are lacking for newer antibiotic products in resistant Gram-negative bacteria; resulting in a significant obstacle when managing difficult to treat pathogens. Our goal was to determine if cefiderocol is efficacious in treating burn patients with Gram-negative bacterial infections.

Methods

We present 7 patients treated with cefiderocol for multidrug-resistant (MDR) and extensively drug-resistant (XDR) infections. Ages ranged from 7 to 64 years old, with burn size 8–97.9 % total body surface area. Six patients had flame burn injuries while one had an electrical injury. Four patients sustained inhalation injury and five required continuous renal replacement therapy during their hospital stay. The median ABSI was 13, and the modified Baux score was 123. A median of 9 different antibiotic classes were used per patient prior to cefiderocol. Therapy with cefiderocol ranged from 7 to 80 days with aggressive dosing up to 2 g every 6 h to ensure adequate tissue concentration. Five patients survived and achieved clinical cure. Of the two patients who died, one demonstrated microbiological clearance. Both patients likely died from superinfection with invasive mold. Only one patient demonstrated subsequent cultures resistant to cefiderocol (osteomyelitis) which was cured with amputation. No adverse events were attributed to the cefiderocol regimens. Six of the seven patients showed microbiological clearance for Gram-negative bacteria. Additional studies in patients with large thermal injuries are needed to determine optimal dosing regimens for these hypermetabolic patients.