Mabayoje Diana A, NicFhogartaigh Caoimhe, Cherian Benny P, Tan Mei Gie Meiqi, Wareham David W
Division of Infection, Barts Health NHS Trust, London, UK.
Antimicrobial Research Group, Blizard Institute, Queen Mary University of London, London, UK.
JAC Antimicrob Resist. 2021 Jun 15;3(Suppl 1):i21-i24. doi: 10.1093/jacamr/dlab055. eCollection 2021 Jun.
Cefiderocol is a recently licensed novel siderophore-conjugated cephalosporin stable to hydrolysis by serine and MBLs. It has been successfully used to treat Enterobacterales infections and is approved for the treatment of infections due to aerobic Gram-negative organisms in adults with limited treatment options.
To describe the compassionate use of cefiderocol and clinical outcome in a case of prosthetic joint infection due to MDR .
This case study follows a 66-year-old woman who sustained an open fracture of the left distal humerus in Pakistan. She underwent open reduction and internal fixation and on return to the UK presented to hospital with a discharging surgical wound.
Debridement of her wound cultured NDM carbapenemase-producing susceptible to colistin, tobramycin and tigecycline only. She developed vomiting with acute kidney injury with colistin and tigecycline. Antimicrobial efficacy of cefiderocol was predicted from and susceptibility tests. A successful request was made to Shionogi for compassionate use of cefiderocol, which was added to tigecycline. Cefiderocol was well tolerated with no toxicity and improved renal function. In total she received 25 days of cefiderocol and continued on tigecycline for a further 6 weeks in the community. She has well-healed wounds and good range of elbow movement.
Cefiderocol's novel mode of cell entry is effective against MDR Gram-negative bacteria with reduced toxicity compared with other last line antibiotics. Our case demonstrates that cefiderocol may be useful as therapy for patients with limited treatment options due to antimicrobial resistance.
头孢地尔是一种最近获批的新型铁载体缀合头孢菌素，对丝氨酸和金属β-内酰胺酶介导的水解稳定。它已成功用于治疗肠杆菌科感染，并被批准用于治疗治疗选择有限的成年患者的需氧革兰氏阴性菌感染。
描述头孢地尔在耐多药所致人工关节感染病例中的同情用药情况及临床结局。
本病例研究跟踪了一名66岁女性，她在巴基斯坦发生左肱骨远端开放性骨折。她接受了切开复位内固定术，返回英国后因手术伤口流脓而入院。
她伤口清创培养出产NDM碳青霉烯酶的菌株，仅对黏菌素、妥布霉素和替加环素敏感。她在使用黏菌素和替加环素时出现呕吐并伴有急性肾损伤。根据 和 药敏试验预测了头孢地尔的抗菌效果。已成功向盐野义公司申请同情使用头孢地尔，并将其添加到替加环素中。头孢地尔耐受性良好，无毒性，肾功能得到改善。她总共接受了25天的头孢地尔治疗，并在社区继续使用替加环素6周。她的伤口愈合良好，肘关节活动范围正常。
头孢地尔独特的细胞进入模式对耐多药革兰氏阴性菌有效，与其他最后一线抗生素相比毒性更低。我们的病例表明，对于因抗菌药物耐药性导致治疗选择有限的患者，头孢地尔可能是一种有用的治疗方法。
