Real-life experience with use of cefiderocol in non-critically ill patients in a tertiary care hospital

Background

Clinical experience with cefiderocol is limited to a few patients with multidrug-resistant (MDR) infections. Moreover, the data has been collected primarily in critically ill patients. Thus, there is a need to increase the information regarding the use of cefiderocol in clinical practice in more types of patients.

Objectives

To evaluate the effectiveness and safety of cefiderocol in clinical practice in non-critical patients.

Methods

A retrospective observational study including all adult patients treated with cefiderocol between January 2020 and March 2023 in a tertiary hospital. Patients with a prescription at an intensive care unit were excluded. Effectiveness was measured in terms of clinical and microbiological cure seven days after the end of treatment. To assess safety, adverse effects potentially associated with cefiderocol were collected.

Results

A total of 17 patients (80% men) with a median age of 57 (IQR 53–64) years were included. The predominant focus of infection was urinary (47%). The main causal microorganism of the infection was Pseudomonas aeruginosa (59%). Eleven isolates (65%) were carbapenemase-producing gram-negative bacilli (GNB); the rest (35%) was classified as extensively-drug resistant GNB (XDR-GNB) with other resistance mechanisms. The isolated carbapenemases were one GES, one KPC, eight metallobetalactamases (seven VIM type and one NDM), and one carbapenemase without type identification. Treatment with cefiderocol was completed in all the patients. Fifteen (88%) patients were clinically cured. Regarding microbiological cure, 12 (70%) had negative cultures. No patient presented adverse effects potentially associated with cefiderocol.

Conclusion

Cefiderocol achieves clinical and microbiological improvement in non-critical patients with infections with limited therapeutic options while maintaining a good safety profile.