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Real-life experience with compassionate use of cefiderocol for difficult-to-treat resistant Pseudomonas aeruginosa (DTR-P) infections.
Meschiari, Marianna; Volpi, Sara; Faltoni, Matteo; Dolci, Giovanni; Orlando, Gabriella; Franceschini, Erica; Menozzi, Marianna; Sarti, Mario; Del Fabro, Giovanni; Fumarola, Benedetta; Guarneri, Francesco; Lanza, Paola; Lorenzotti, Silvia; Saccani, Barbara; Signorini, Liana; Van Hauwermeiren, Evelyn; Gatti, Milo; Pea, Federico; Castelli, Francesco; Mussini, Cristina.
  • Meschiari M; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
  • Volpi S; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
  • Faltoni M; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
  • Dolci G; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
  • Orlando G; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
  • Franceschini E; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
  • Menozzi M; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
  • Sarti M; Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy.
  • Del Fabro G; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.
  • Fumarola B; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.
  • Guarneri F; Department of Infectious Diseases, University of Brescia, Brescia, Italy.
  • Lanza P; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.
  • Lorenzotti S; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.
  • Saccani B; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.
  • Signorini L; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.
  • Van Hauwermeiren E; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.
  • Gatti M; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.
  • Pea F; SSD Clinical Pharmacology, Alma Mater Studiorum, University of Bologna, University Hospital IRCCS Policlinico Sant'Orsola Malpighi, Bologna, Italy.
  • Castelli F; SSD Clinical Pharmacology, Alma Mater Studiorum, University of Bologna, University Hospital IRCCS Policlinico Sant'Orsola Malpighi, Bologna, Italy.
  • Mussini C; University Division of Infectious and Tropical Diseases, ASST Spedali Civili, Brescia, Italy.
JAC Antimicrob Resist ; 3(4): dlab188, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1575038
ABSTRACT

OBJECTIVES:

To describe our real-life experience with cefiderocol in XDR and difficult-to-treat resistant Pseudomonas aeruginosa (DTR-P) infections without any other available treatment options.

METHODS:

We included patients with a proven infection due to an XDR/DTR-P, who had failed on previous regimens, and were treated with cefiderocol, following them prospectively to day 90 or until hospital discharge or death.

RESULTS:

Seventeen patients treated for >72 h with cefiderocol were included 14 receiving combination regimens (82.4%) and 3 receiving monotherapy (17.6%). Fourteen patients were males (82%) with a median age of 64 years (IQR 58-73). Fifteen patients (88.2%) were admitted to the ICU and five had septic shock (29%). Seven cases (41.2%) were ventilator-associated pneumonia, of which 71% (5/7) occurred in COVID-19 patients. Four were complicated intrabdominal infections, one ecthyma gangrenosum, one nosocomial pneumonia and one empyema, one osteomyelitis, one primary bacteraemia, and one nosocomial external ventricular drainage meningitis. Clinical cure and microbiological cure rates were 70.6% and 76.5%, respectively. There were six deaths (35.3%) after a median of 8 days (IQR 3-10) from the end of treatment, but only two of them (11.7%) were associated with P. aeruginosa infection progression.

CONCLUSIONS:

Our experience collecting this large case series of DTR-P treated with cefiderocol may help clinicians consider this new option in this hard-to-manage setting. Our results are even more relevant in the current scenario of ceftolozane/tazobactam shortage. Importantly, this is the first study providing real-life data indicating adequate cefiderocol concentrations in CSF.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study Language: English Journal: JAC Antimicrob Resist Year: 2021 Document Type: Article Affiliation country: Jacamr

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study Language: English Journal: JAC Antimicrob Resist Year: 2021 Document Type: Article Affiliation country: Jacamr