Background and importance Recently new antibiotics were introduced in our hospital formulary for the treatment of serious infections caused by multidrug-resistant (MDR) organisms (CRE, ESBL, MDR-PA, CRA-AB). Cefiderocol, thanks to its structure and mechanism of action, may play a unique role in patients who have limited or no alternative treatment options.
Aim and objectives The aim of this study was to describe the first cases of prescriptions of cefiderocol used in the 5 months following its availability in Italy, and the hospital pharmacist interventions in assisting clinicians from microbiology select a safe and appropriate antibiotic treatment.
Material and methods A standardised prescription form was sent to the infectious disease specialist to collect patients’ characteristics, infection type, reasons for cefiderocol use, doses and duration of treatment (concomitant treatments, adverse events and outcome). A susceptibility testing kit (30 μg cefiderocol disc) was provided to the microbiology specialist in order to reserve this new antibiotic for patients with cefiderocol-susceptible isolates. A retrospective study was performed to collect the data of adult patients who received cefiderocol.
Results A total of 30 patients with mean age of 56 (23–90) years received cefiderocol (9 females, 21 males). Of these, 19 patients were treated in intensive care units, with the most common regimen of 2 g three times/day tid (n=6), while 3 patients with acute renal failure required a regimen of 750 mg twice daily. The main sites of infection were respiratory tract (n=16), urinary tract (n=3), intra-abdominal (n=4) and bloodstream (n=5). 5 patients had multisite infections.
The duration of therapy was in the range 6–16 days. The most common pathogens were Acinetobacter baumannii (n=13), Klebsiella pneumoniae (n= 8), Pseudomonas aeuroginosa (n=10) and Enterobacter spp (n=5). 10 patients had superinfections. The most concomitant therapy was colistin (n=9). No severe adverse events were reported. 7 patients with septic shock died.
Conclusion and relevance Our study describes real-life experience of the use of cefiderocol as a salvage option in critical patients, providing additional data on its benefit, safety and limits in both empirical and targeted treatment of multidrug-resistant Gram-negative bacteria (MDR-GNB) infections, and it confirms the need for a multidisciplinary team.
Conflict of interest No conflict of interest