Use of Cefiderocol in Adult Patients: Descriptive Analysis from a Prospective, Multicenter, Cohort Study
- Authors: Giacobbe, Daniele Roberto; Labate, Laura; Russo Artimagnella, Chiara; Marelli, Cristina; Signori, Alessio; Di Pilato, Vincenzo; Aldieri, Chiara; Bandera, Alessandra; Briano, Federica; Cacopardo, Bruno; Calabresi, Alessandra; Capra Marzani, Federico; Carretta, Anna; Cattelan, Annamaria; Ceccarelli, Luca; Cenderello, Giovanni; Corcione, Silvia; Cortegiani, Andrea; Cultrera, Rosario; De Rosa, Francesco Giuseppe; Del Bono, Valerio; Del Puente, Filippo; Fanelli, Chiara; Fava, Fiorenza; Francisci, Daniela; Geremia, Nicholas; Graziani, Lucia; Lombardi, Andrea; Losito, Angela Raffaella; Maida, Ivana; Marino, Andrea; Mazzitelli, Maria; Merli, Marco; Monardo, Roberta; Mularoni, Alessandra; Oltolini, Chiara; Pallotto, Carlo; Pontali, Emanuele; Raffaelli, Francesca; Rinaldi, Matteo; Ripa, Marco; Santantonio, Teresa Antonia; Serino, Francesco Saverio; Spinicci, Michele; Torti, Carlo; Trecarichi, Enrico Maria; Tumbarello, Mario; Mikulska, Malgorzata; Giacomini, Mauro; Marchese, Anna; Vena, Antonio; Bassetti, Matteo; Murgia, Ylenia; Di Meco, Gabriele; Cappello, Alice; Guastavino, Sabrina; Campi, Cristina; Piana, Michele; Mora, Sara; Rosso, Nicola; Di Biagio, Antonio; Viglietti, Giulia; Brunetti, Iole; Robba, Chiara; Ball, Lorenzo; Battaglini, Denise; Portunato, Federica; Giannella, Maddalena; Viale, Pierluigi; Viero, Giulia; Azzarà , Cecilia; Bartoloni, Alessandro; Casciato, Benedetta; Grillo, Chiara; Cibelli, Donatella; Boni, Silvia; Feasi, Marcello; Del Giacomo, Paola; Baldin, Gianmaria; D'Amico, Federico; Travi, Giovanna; Fasciana, Teresa; Catalisano, Giulia; Giarratano, Antonino; Baranello, Elena; Albagini, Margherita; Maci, Chiara; Castagna, Antonella; Grosso, Cecilia; Shbaklo, Nour; Momesso, Elena; Boffa, Nicoletta; Potenza, Elena; Scaglione, Vincenzo; Mengato, Daniele; Russo, Alessandro; Corsello, Ludovica; Serapide, Francesca; Rizzo, Monica; Asperges, Erika; Truffelli, Francesco; Sambo, Margherita; Giuliano, Gabriele; Fele, Francesco; Gullotta, Chiara; Campanella, Edoardo; Meloni, Maria Chiara; Boraso, Sabrina; Panese, Sandro; Bonazza, Aurora; Scolz, Kristian; Coppo, Erika; Berruti, Marco; null, null
- Publication year: 2024
- Type: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/647034
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.