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4CPS-137 Cefiderocol: utilisation profile in the treatment of multidrug-resistant bacteria, a retrospective overview
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  1. A Calvo García,
  2. A Ibáñez Zurriaga,
  3. M Pérez Abánades,
  4. E Ramírez Herráiz,
  5. S Ruíz-García,
  6. G Escudero Sánchez,
  7. A Collado Mohedano,
  8. A Aranguren Oyarzabal,
  9. A Morell Baladrón
  1. Hospital Universitario De La Princesa, Pharmacy, Madrid, Spain

Abstract

Background and Importance Gram-negative bacterial multidrug-resistance has reached alarming levels worldwide. Cefiderocol is a novel siderophore-cephalosporin conjugate, with activity against carbapenem-resistant and multidrug-resistant gram-negative bacilli.

Aim and Objectives To describe the utilisation profile of cefiderocol in the treatment of multidrug-resistant gram-negative infections.

Material and Methods Retrospective study including all patients treated with cefiderocol during March 2021 to July 2023. Patient demographics (age, sex, hospital stay, intensive care unit (ICU)) stay, and clinical and infectious variables (infection/colonisation site, isolated gram-negative bacteria, and mechanisms of resistance) were collected. Statistical analysis: values were expressed as medians (interquartile range) and patients (percentages).

Results Fifty-three patients started treatment with cefiderocol: 10/53 (18.9%) colonisations and 43/53 (81.1%) active infections. 34/53 (64.2%) were male with a median age of 65.6 (56.6–72.3) years. The median hospital stay was 57.3 (31.5–82.2) days, 31/53 patients (58.5%) required admission to the ICU, with a median stay of 40.0 (25.0–76.5) days. The main focus of infection was respiratory (16/53, 30.2%), followed by urinary (10/53, 18.9%), intra-abdominal (5/53, 9.4%), skin and soft tissue (5/53, 9.4%), endovascular (4/53, 7.5%) and osteoarticular (3/53, 5.7%); and 10/53 (18.9%) were colonisation samples (rectal exudates). 7/53 (13.2%) patients had another focus and 11/53 (20.8%) had sepsis. A total of 73 isolates of multidrug-resistant gram-negative bacteria were obtained. Microorganisms with more than one isolation were: 18/73 (24.7%) IMP carbapenemase-producing Pseudomonas aeruginosa, 7/73 (9.6%) VIM carbapenemase-producing Pseudomonas putida, 6/73 (8.2%) multidrug-resistant Stenotrophomonas maltophilia, 5/73 (6.8%) Carbapenem-resistant Acinetobacter baumannii, 4/73 (5.5%) VIM carbapenemase-producing Pseudomonas aeruginosa, 3/73 (4.1%) IMP carbapenemase-producing Klebsiella oxytoca, 3/73 (4.1%) VIM carbapenemase-producing Klebsiella oxytoca, 3/73 (4.1%) VIM carbapenemase-producing Serratia marcescens, 2/73 (2.7%) multidrug-resistant Proteus mirabilis and 2/73 (2.7%) multidrug-resistant Pseudomonas aeruginosa. Just 4/57 isolates with resistance to cefiderocol were recorded. In 5/43 (11.6%) patients treatment was empirical. The median duration of treatment was 9.0 (6.0–15.0) days.

Conclusion and Relevance Cefiderocol was mainly used as a targeted treatment of respiratory and urinary tract infections in a population with long hospital stays and a high rate of ICU admission. Most of the isolated bacteria presented carbapenemases, especially VIM and IMP, with a low resistance ratio to cefiderocol. Therefore, cefiderocol was well utilised, being restricted to patients with severe infections caused by pathogens with carbapenemases.

Conflict of Interest No conflict of interest.

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