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.
Use of Cefiderocol in Adult Patients: Descriptive Analysis from a Prospective, Multicenter, Cohort Study / Giacobbe, D. R.; 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, F. G.; Del Bono, V.; Del Puente, F.; Fanelli, C.; Fava, F.; Francisci, D.; Geremia, N.; Graziani, L.; Lombardi, A.; Losito, A. R.; 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, T. A.; Serino, F. S.; Spinicci, M.; Torti, C.; Trecarichi, E. M.; Tumbarello, M.; Mikulska, M.; Giacomini, M.; Marchese, A.; Vena, A.; Bassetti, M.; Murgia, Y.; Di Meco, G.; Cappello, A.; Guastavino, S.; Campi, C.; Piana, M.; Mora, S.; Rosso, N.; Di Biagio, A.; Viglietti, G.; Brunetti, I.; Robba, C.; Ball, L.; Battaglini, D.; Portunato, F.; Giannella, M.; Viale, P.; Viero, G.; Azzara, C.; Bartoloni, A.; Casciato, B.; Grillo, C.; Cibelli, D.; Boni, S.; Feasi, M.; Del Giacomo, P.; Baldin, G.; D'Amico, F.; Travi, G.; Fasciana, T.; Catalisano, G.; Giarratano, A.; Baranello, E.; Albagini, M.; Maci, C.; Castagna, A.; Grosso, C.; Shbaklo, N.; Momesso, E.; Boffa, N.; Potenza, E.; Scaglione, V.; Mengato, D.; Russo, A.; Corsello, L.; Serapide, F.; Rizzo, M.; Asperges, E.; Truffelli, F.; Sambo, M.; Giuliano, G.; Fele, F.; Gullotta, C.; Campanella, E.; Meloni, M. C.; Boraso, S.; Panese, S.; Bonazza, A.; Scolz, K.; Coppo, E.; Berruti, M.. - In: INFECTIOUS DISEASES AND THERAPY. - ISSN 2193-6382. - (2024). [10.1007/s40121-024-01016-y]
Use of Cefiderocol in Adult Patients: Descriptive Analysis from a Prospective, Multicenter, Cohort Study
Carretta A.;Fanelli C.;Marino A.;Merli M.;Monardo R.;Ripa M.;Marchese A.;D'Amico F.;Maci C.;Castagna A.;
2024-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
