Use of cefiderocol for multidrug-resistant Acinetobacter baumannii in patients with SARS-CoV-2: two case reports

ABSTRACT

Background and importanceCefiderocol is a new siderophore cephalosporin for the treatment of multidrug-resistant Gram-negative pathogens such as Acinetobacter baumannii (AB).Aim and objectivesTo describe our clinical experience with cefiderocol use in two SARS-CoV-2 patients with ventilator-associated pneumonia (VAP) due to multidrug-resistant AB (MRAB).Material and methodsA descriptive retrospective study on cefiderocol therapy in two patients with MRAB was conducted until 31 Augsut 2021. The electronic medical record was used to collect data comorbidities, baseline clinical context, treatment, and clinical evolution of patients.ResultsA 49-year-old man with hypertension, obesity and chronic renal insufficiency was diagnosed with SARS-CoV-2. He required orotracheal intubation (OI) and mechanical ventilation (MV). The patient presented VAP after 4 weeks in the intensive care unit (ICU). Panresistant AB was isolated from bronchoalveolar lavage (BAL) and was treated with cefepime, imipenem, tigecycline and nebulised colistin. Given his poor clinical improvement, cefiderocol 2 g/8 hours (14 days) was initiated. No renal dose adjustment was performed for cefiderocol. Clinical evolution was favourable. The patient remained afebrile and acute phase reactants (APR) decreased. Unfavourable evolution and increased APR were observed on the third day after treatment with cefiderocol, with presence of AB in BAL. The patient died of multiorgan dysfunction syndrome 8 days later.A 65-year-old man with hypertension, dyslipidaemia and diabetes was diagnosed with SARS-CoV-2. He required OI and MV. After 4 weeks in ICU, the patient presented VAP due to MRAB and coinfection with Mycoplasma pneumoniae. Tigecycline, nebulised colistin and ceftazidime/avibactam were used. A clinical worsening was observed and cefiderocol 2 g/8 hours (14 days) and amikacin (5 days) were started. The patient remained afebrile and APR slightly decreased after initiation of cefiderocol and amikacin treatments. BAL culture was negative, although AB colonisation persisted in pharynx. Tigecycline, piperacillin/tazobactam and nebulised colistin were administered. After 71 days in ICU, the patient was transferred to a hospital ward, where he remained for 98 days before discharge.Conclusion and relevanceThe use of cefiderocol led to a slight improvement in two patients with VAP caused by MRAB. One patient died due to multiorgan dysfunction syndrome after cefiderocol therapy, and the other case required subsequent antibiotherapy due to persistence of MRAB.References and/or acknowledgementsConflict of interestNo conflict of interest