Cefiderocol treatment in COVID-19 positive patients co-infected with pan-resistant pseudomonas aeruginosa

ABSTRACT

Background and ImportanceImmunosuppression due to SARS-CoV2 infection (COVID19) has caused an increase in identification of multi-resistant organisms in Intensive Care Units (ICU), among which multi-resistant Pseudomonas aeruginosa rise about others. Cefiderocol is a costly new cephalosporin against extensively resistant Gram-negative bacteria.Aim and ObjectivesThe objective of this study is to describe the characteristics and clinical results of patients treated with cefiderocol, as well as the dosage of this treatment, in ICU inpatients with COVID19 pneumonia and co-infected with pan-resistant Pseudomonas aeruginosa.Material and MethodsRetrospective observational study carried out in a general hospital from September 2020 to December 2021. Inpatients at ICU diagnosed with COVID-19 pneumonia that were treated with cefiderocol due to P. aeruginosa infection were included. Collected data were days admitted in ICU, days of treatment with cefiderocol, concomitant treatment, cefiderocol dosage and results of the treatment.ResultsThree patients fulfilled the inclusion criteria among 70 patients admitted to ICU with COVID-19 in the study period (4.3%). All patients included were men and the median age was 66.6 ± 6.5 years old. They presented as comorbidities obesity, hypertension and diabetes mellitus. They were admitted during 87 ± 28.6 days, with detection of pan-resistant P. aeruginosa in the range of 32.5 ± 2.1 days after admission at ICU. All of these cultures were only sensitive to cefiderocol, being resistant to all other tested antibiotics. Due to that, all patients received cefiderocol during their stay and dose adjustment to their renal function or renal replacement therapy were applied. Every patient received a bolus of 2 grams in 30 minutes and the maintenance dose in at least 3 hours. The average of treatment days was 20.5 ± 4.5 days. In all cases, the isolated strains were sensitive to colistin, so cefiderocol was used in combination with it. The results of the treatment were disparate one cure, one death, and one development of resistance to cefiderocol.Conclusion and RelevanceCefiderocol use for multi-resistant bacteria treatment requires prior knowledge of its pharmacokinetics, taking into account the physiological factors of patients in its dosage. New treatments are not exempt from the development of resistance.References and/or AcknowledgementsConflict of InterestNo conflict of interest