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Use of Cefiderocol in Adult Patients: Descriptive Analysis from a Prospective, Multicenter, Cohort Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年7月12日

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  • Daniele Roberto Giacobbe,
  • Laura Labate,
  • Chiara Russo Artimagnella,
  • Cristina Marelli,
  • Alessio Signori,
  • Vincenzo Di Pilato,
  • Chiara Aldieri,
  • Alessandra Bandera,
  • Federica Briano,
  • Bruno Cacopardo,
  • Alessandra Calabresi,
  • Federico Capra Marzani,
  • Anna Carretta,
  • Annamaria Cattelan,
  • Luca Ceccarelli,
  • Giovanni Cenderello,
  • Silvia Corcione,
  • Andrea Cortegiani,
  • Rosario Cultrera,
  • Francesco Giuseppe De Rosa,
  • Valerio Del Bono,
  • Filippo Del Puente,
  • Chiara Fanelli,
  • Fiorenza Fava,
  • Daniela Francisci,
  • Nicholas Geremia,
  • Lucia Graziani,
  • Andrea Lombardi,
  • Angela Raffaella Losito,
  • Ivana Maida,
  • Andrea Marino,
  • Maria Mazzitelli,
  • Marco Merli,
  • Roberta Monardo,
  • Alessandra Mularoni,
  • Chiara Oltolini,
  • Carlo Pallotto,
  • Emanuele Pontali,
  • Francesca Raffaelli,
  • Matteo Rinaldi,
  • Marco Ripa,
  • Teresa Antonia Santantonio,
  • Francesco Saverio Serino,
  • Michele Spinicci,
  • Carlo Torti,
  • Enrico Maria Trecarichi,
  • Mario Tumbarello,
  • Malgorzata Mikulska,
  • Mauro Giacomini,
  • Anna Marchese,
  • Antonio Vena,
  • Matteo Bassetti,
  • Ylenia Murgia,
  • Gabriele Di Meco,
  • Alice Cappello,
  • Sabrina Guastavino,
  • Cristina Campi,
  • Michele Piana,
  • Sara Mora,
  • Nicola Rosso,
  • Antonio Di Biagio,
  • Giulia Viglietti,
  • Iole Brunetti,
  • Chiara Robba,
  • Lorenzo Ball,
  • Denise Battaglini,
  • Federica Portunato,
  • Maddalena Giannella,
  • Pierluigi Viale,
  • Giulia Viero,
  • Cecilia Azzarà,
  • Alessandro Bartoloni,
  • Benedetta Casciato,
  • Chiara Grillo,
  • Donatella Cibelli,
  • Silvia Boni,
  • Marcello Feasi,
  • Paola Del Giacomo,
  • Gianmaria Baldin,
  • Federico D’Amico,
  • Giovanna Travi,
  • Teresa Fasciana,
  • Giulia Catalisano,
  • Antonino Giarratano,
  • Elena Baranello,
  • Margherita Albagini,
  • Chiara Maci,
  • Antonella Castagna,
  • Cecilia Grosso,
  • Nour Shbaklo,
  • Elena Momesso,
  • Nicoletta Boffa,
  • Elena Potenza,
  • Vincenzo Scaglione,
  • Daniele Mengato,
  • Alessandro Russo,
  • Ludovica Corsello,
  • Francesca Serapide,
  • Monica Rizzo,
  • Erika Asperges,
  • Francesco Truffelli,
  • Margherita Sambo,
  • Gabriele Giuliano,
  • Francesco Fele,
  • Chiara Gullotta,
  • Edoardo Campanella,
  • Maria Chiara Meloni,
  • Sabrina Boraso,
  • Sandro Panese,
  • Aurora Bonazza,
  • Kristian Scolz,
  • Erika Coppo,
  • Marco Berruti

摘要

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.