ABSTRACT
Background. Cefiderocol (CFDC) is a Gram-negative antibiotic (GNA) with a unique mode of cell entry against carbapenem resistance. This study described the initial use of CFDC in US hospitals since its approval in November 2019. Methods. This was a retrospective study of patients treated with CFDC consecutively for >=3 days in US hospitals, as captured in Premier Healthcare Data from January 2020 to June 2021. This study described the clinical characteristics, CFDC usage, and Post-CFDC initiation 14-day and 28-day in-hospital all-cause mortality (IH-ACM). For patients with microbiology results, the pathogen, susceptibility and culture site associated with CFDC use were described. Index culture was the culture(s) taken on the day closest to CFDC initiation. Results. Among 313 of 360 in-patients who received >=3 days CFDC, the median age was 58 years (range: 17 - 89 years), and 91% were hospitalized via emergency room, trauma, or urgent admission. The most common conditions were severe sepsis with septic shock, palliative care, and multi-drug resistant infection. Also 34% had a 'do not resuscitate order'. About 64% of patients received mechanical ventilation and 79% had ICU stay. Median length of hospital stay was 27 days (range: 3-310 days). Median days on CFDC was 8 days (range: 3 - 66 days). Over 58% received >=2 other GNAs within 14-days of initiatingCFDC.Among 187 patients withmicrobiology results, 75% had index cultures with one pathogen, and 73% had confirmed carbapenem resistant pathogens. The most common pathogens were Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Klebsiella pneumoniae and Acinetobacter baumannii. The most common index culture site was respiratory. The 14-day and 28-day crude IH-ACM from CFDC initiation was 16.3% (95%CI: 12.2%-20.4%) and 23.6% (95%CI: 18.9 - 28.4%), respectively. Among those with microbiology results, 14-day and 28-day IH-ACMwas 17.1% (95%CI: 11.7% - 22.5%) and 23.5%(95%CI: 17.4-29.6%), respectively. Among patients who died, 83% had severe sepsis with septic shock, 76% were in palliative care, 71% had a 'do not resuscitate order', and 44% had COVID-19. Conclusion. CFDC was used most frequently in critically ill patients. IH-ACM was comparable with other studies.
ABSTRACT
SESSION TITLE: Late Breaking Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Cefiderocol is a siderophore cephalosporin that has broad activity against Gram-negative (GN) pathogens including carbapenem resistant isolates through its unique mode of cell entry. This study describes the usage of cefiderocol in US hospitals, in patients with microbiology confirmed respiratory infections, during its first 1.5 years following commercial availability. METHODS: This was a retrospective study of patients with microbiology confirmed GN respiratory infections in US hospitals, treated with cefiderocol consecutively for ≥3 days between January 2020 to June 2021, as captured by the Premier Healthcare database. This study describes the clinical characteristics, microbiology profile, and 14-day and 28-day in-hospital all-cause mortality (IH-ACM) amongst patients treated with cefiderocol. Index culture was defined as the last culture sample(s) obtained before cefiderocol initiation, or the first culture obtained after cefiderocol initiation if no microbiology evaluation was performed prior to cefiderocol use. Index pathogen(s) were the pathogen(s) identified from the index culture(s). RESULTS: Among 113 hospitalized patients who received ≥3 days cefiderocol and had ≥1 positive respiratory culture for GN pathogens, median age was 61 years with interquartile range (IQR) of 48-72 years, 57% were male, and 93% were admitted via emergency room or urgent care. The most common comorbidities were renal disease (37%), diabetes (36%), congestive heart failure (35%), and chronic pulmonary disease (33%). Seventy-seven percent of patients received mechanical ventilation and 89% were treated in an intensive care unit. The most frequent index pathogens were Pseudomonas aeruginosa (56%), Stenotrophomonas maltophilia (24%), Klebsiella pneumoniae (13%), and Acinetobacter baumannii (11%). Also 28% of patients had more than one pathogen from index cultures and over 10% also had positive GN index cultures from other sites such as blood, urine or wound. Among 96 pathogens tested for carbapenems, 87% were resistant. Median time from hospital admission to cefiderocol initiation was 14 days (IQR: 5-25). Median cefiderocol duration was 8 days (IQR: 6-14). Before initiating cefiderocol, 88% of patients received other GN antibiotics. Median length of hospital stay was 28 days (IQR: 16-45). Crude 14-day and 28-day IH-ACM were 21.2% (95%CI: 13.7%-28.8%) and 27.4% (95%CI: 19.2-35.7%), respectively. IH-ACM was higher in COVID patients than non-COVID patient (53.1% vs. 8.6% for 14-day ACM and 65.6% vs. 12.3% for 28-day ACM, respectively). CONCLUSIONS: During the initial phase of availability, the most frequent use of cefiderocol was to treat critically ill patients with non-fermenter pathogen infections.IH-ACM appears to be affected by infection characteristics, especially COVID-19 status. CLINICAL IMPLICATIONS: Real-world data supports that Cefiderocol is effective in treating GN respiratory infections as shown in IH-ACM DISCLOSURES: Employee relationship with Shionogi Inc Please note: 2015 - present Added 06/02/2022 by Bin Cai, value=Salary No relevant relationships by Andrew Cooper Employee relationship with Shionogi, Inc Please note: 3 years Added 06/03/2022 by Stephen Marcella, value=Salary No relevant relationships by Yun Zhou