Department of Clinical and Experimental Medicine, University of Pisa, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
Microbiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
Antimicrob Agents Chemother. 2022 May 17;66(5):e0214221. doi: 10.1128/aac.02142-21. Epub 2022 Mar 21.
Cefiderocol may represent a therapeutic option for carbapenem-resistant Acinetobacter baumannii (CRAB) infections, but clinical data are limited. This is an observational retrospective study conducted in the University Hospital of Pisa including consecutive patients with CRAB infections (January 2020 to August 2021). Patients were divided in two study groups according to the antibiotic treatment received: cefiderocol- and colistin-containing regimens. The primary outcome was the 30-day mortality. A Cox regression analysis was performed to identify factors independently associated with 30-day mortality. A propensity score analysis using inverse probability of treatment weighting (IPTW) was also performed. A total of 124 patients were included: 47 (37.9%) received cefiderocol, while 77 (62.1%) colistin-containing regimens. Overall, 79 (63.7%) patients had a bloodstream infection (BSI), 35 (28.5%) a ventilator-associated pneumonia (VAP) and 10 (8.1%) other infections. Thirty-day mortality was higher in patients receiving colistin- compared to those who received cefiderocol-containing regimens (55.8% versus 34%, = 0.018). This difference was confirmed in patients with BSI, but not in those with VAP. On multivariable analysis, septic shock, SOFA score, and age were independently associated with 30-day mortality, while cefiderocol therapy was protective in an IPTW analysis (Hazard ratio 0.44, 95% confidence interval 0.22-0.66, < 0.001). Nephrotoxicity was more common in the colistin group. Microbiological failure occurred in 17.4% of patients receiving cefiderocol 6.8% of those receiving colistin ( = 0.079). Among 8 cases in the cefiderocol group who experienced microbiological failure, 4 (50%) developed resistance to cefiderocol. Cefiderocol represents a promising therapeutic option in patients with severe CRAB infections. Randomized clinical trial in this specific patient population should confirm our findings.
头孢他啶-阿维巴坦可能是治疗碳青霉烯类耐药鲍曼不动杆菌（CRAB）感染的一种治疗选择，但临床数据有限。这是一项在比萨大学医院进行的观察性回顾性研究，纳入了连续的 CRAB 感染患者（2020 年 1 月至 2021 年 8 月）。根据接受的抗生素治疗方案，患者分为两组：头孢他啶-阿维巴坦和多粘菌素组。主要结局是 30 天死亡率。采用 Cox 回归分析确定与 30 天死亡率相关的独立因素。还进行了基于逆概率治疗加权（Inverse Probability of Treatment Weighting，IPTW）的倾向评分分析。共纳入 124 例患者：47 例（37.9%）接受头孢他啶-阿维巴坦治疗，77 例（62.1%）接受多粘菌素组治疗。总体而言，79 例（63.7%）患者为血流感染（BSI），35 例（28.5%）为呼吸机相关性肺炎（VAP），10 例（8.1%）为其他感染。与接受头孢他啶-阿维巴坦治疗的患者相比，接受多粘菌素治疗的患者 30 天死亡率更高（55.8% vs. 34%，= 0.018）。这一差异在 BSI 患者中得到证实，但在 VAP 患者中没有得到证实。多变量分析显示，感染性休克、SOFA 评分和年龄与 30 天死亡率独立相关，而 IPTW 分析表明头孢他啶-阿维巴坦治疗具有保护作用（风险比 0.44，95%置信区间 0.22-0.66，<0.001）。多粘菌素组的肾毒性更常见。接受头孢他啶-阿维巴坦治疗的患者中有 17.4%发生微生物学失败，而接受多粘菌素治疗的患者中有 6.8%（=0.079）。在头孢他啶-阿维巴坦组的 8 例微生物学失败患者中，有 4 例（50%）对头孢他啶-阿维巴坦产生耐药。头孢他啶-阿维巴坦是治疗严重 CRAB 感染患者的一种有前途的治疗选择。在这一特定患者人群中进行的随机临床试验应证实我们的研究结果。
