Background and importance The detection and dissemination of pan-resistant bacteria in hospitals is relatively frequent. It is necessary to know new therapeutic alternatives available to eradicate them.

Aim and objectives The aim of this study was to evaluate the effectiveness and safety of cefiderocol in the management of pan-resistant Stenotrophomonas maltophilia (SM) isolated in a retroperitoneal collection.

Material and methods Description of a clinical case. The microbiological cure, defined as the eradication of SM in the material extracted from the abdominal abscess, was established as the effectiveness criteria and the non-presentation of adverse effects (AE) as the safety criteria.

Results A 72-year-old man with a history of acute lithiasic pancreatitis, chronic liver disease, and cholecystectomy was readmitted to the intensive care unit due to sepsis caused by acute lithiasic pancreatitis. During admission, the patient received several antibiotics: piperacillin/tazobactam, meropenen and linezolid. Day +30, he presented an episode of septic shock whose focus was a retroperitoneal collection in the pararenal space. It was drained percutaneously and SM resistant to cotrimoxazole (drug of choice) and sensitive to levofloxacin was isolated. He was treated for 20 days with levofloxacin 500 mg/12 hours and meropenem 2 g/8 hours. Day +60, he presented a second episode of septic shock (leukocytes: 40.57×10³/μL, neutrophils: 38.58×10³/μL, C-reactive protein (CRP): 274.5 mg/L). In the extracted material, SM resistant to all marketed antibiotics was isolated. The compassionate use of cefiderocol was requested and approved. SM was sensitive to cefiderocol. He was treated with cefiderocol 2 g/8 hours in monotherapy for 21 days. Day +3 of the start of treatment, a surgical drainage was performed to control the focus. SM was not isolated in the extracted material. Day +7 of treatment, once the focus was controlled, the patient remained afebrile, improving clinically and analytically (leukocytes: 8.8×10³/μL, neutrophils: 7.13×10³/μL and CRP: 71.3 mg/L). SM was not re-isolated during the 113-day admission. He was admitted on day +250 for collagenitis and day +377 for septic shock, not isolating SM. He did not present any AE related to cefiderocol.

Conclusion and relevance New therapeutic alternatives must be available for pan-resistant bacteria. Cefiderocol in monotherapy was effective and safe in the treatment of pan-resistant SM.

Conflict of interest No conflict of interest