Department of Mental Health and Public Medicine - Infectious Diseases Unit. University of Campania Luigi Vanvitelli, Naples, Italy.
Department of Precision Medicine, University of Campania Luigi Vanvitelli-Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
J Infect Public Health. 2023 Sep;16(9):1485-1491. doi: 10.1016/j.jiph.2023.06.009. Epub 2023 Jun 14.
No clear evidence supports the use of cefiderocol as first line treatment in A. baumannii infections.
We conducted an observational retrospective/prospective multicenter study including all patients> 18 years with carbapenem-resistant A. baumannii (CRAB) infections treated with cefiderocol, from June 12021 to October 30 2022. Primary endpoint was 30-day mortality, secondary end-points the clinical and microbiological response at 7 days and at the end of treatment. Furthermore, we compared the clinical and microbiological outcomes among patients who received cefiderocol in monotherapy or in combination.
Thirty-eight patients with forty episodes of infection were included [mean age 65 years (SD+16.3), 75% males, 90% with hospital-acquired infections and 70% showing sepsis or septic shock]. The most common infections included unknown source or catheter-related bacteremia (45%) and pneumonia (40%). We observed at 7 days and at the end of therapy a rate of microbiological failure of 20% and 10%, respectively, and of clinical failure of 47.5% and 32.5%, respectively; the 30-day mortality rate was 47.5%. At multivariate analysis clinical failure at 7 days of treatment was the only independent predictor of 30-day mortality. Comparing monotherapy (used in 72.5%) vs. combination therapy (used in 27.5%), no differences were observed in mortality (51.7 vs 45.5%) and clinical (41.4 vs 63.7%) or microbiological failure (24.1 vs 9.1%).
The findings of this study reinforce the effectiveness of cefiderocol in CRAB infections, also as monotherapy. However, prospective multicenter studies with larger sample sizes and a control group treated with standard of care are needed to identify the best treatment for CRAB infections.
目前尚无明确证据支持将头孢他啶-阿维巴坦作为鲍曼不动杆菌感染的一线治疗药物。
我们开展了一项观察性回顾性/前瞻性多中心研究，纳入了 2021 年 6 月至 2022 年 10 月期间所有接受头孢他啶-阿维巴坦治疗的年龄>18 岁、耐碳青霉烯类鲍曼不动杆菌（CRAB）感染患者。主要终点为 30 天死亡率，次要终点为治疗第 7 天和治疗结束时的临床和微生物学应答。此外，我们比较了接受头孢他啶-阿维巴坦单药治疗和联合治疗患者的临床和微生物学结局。
共纳入 38 例患者的 40 例感染[平均年龄 65 岁（标准差+16.3），75%为男性，90%为医院获得性感染，70%存在脓毒症或感染性休克]。最常见的感染包括不明来源或导管相关菌血症（45%）和肺炎（40%）。我们观察到治疗第 7 天和治疗结束时，微生物学失败率分别为 20%和 10%，临床失败率分别为 47.5%和 32.5%；30 天死亡率为 47.5%。多变量分析显示，治疗第 7 天临床失败是 30 天死亡率的唯一独立预测因素。在比较单药治疗（72.5%）与联合治疗（27.5%）时，死亡率（51.7% vs 45.5%）、临床（41.4% vs 63.7%）或微生物学失败率（24.1% vs 9.1%）均无差异。
本研究结果强化了头孢他啶-阿维巴坦治疗 CRAB 感染的有效性，单药治疗同样有效。然而，仍需开展更大样本量、以标准治疗为对照的前瞻性多中心研究，以确定治疗 CRAB 感染的最佳方案。
