Koirala Archana, Krishnappa Bharath, Banh Caroline, Brandenburg Ulrike, Findlay Michael, Williams Phoebe C M
From the Department of Infectious Diseases, Nepean Hospital, Kingswood, New South Wales, Australia.
National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia.
Pediatr Infect Dis J. 2023 Nov 1;42(11):1012-1016. doi: 10.1097/INF.0000000000004051. Epub 2023 Jul 24.
Ventilator-associated pneumonia (VAP) caries a morbidity and mortality risk in the preterm neonate, particularly in the context of rising global antimicrobial resistance driving infections due to multidrug-resistant Gram-negative bacteria. Cefiderocol, a siderophilic cephalosporin, has broad Gram-negative antimicrobial activity and central nervous system penetration and is used for the treatment of hospital-acquired pneumonia or VAP in adults. Scarce data exists on its use in neonates.
A female neonate born at 26 + 6 weeks developed VAP at 21 days of life. She was commenced on corticosteroids, vancomycin and ceftazidime but continued to deteriorate. Sputum cultures yielded Stenotrophomonas maltophilia resistant to trimethoprim/sulfamethoxazole, ciprofloxacin and ceftazidime, with potential susceptibility to cefiderocol. Cerebrospinal fluid showed an elevated white cell count. In view of worsening respiratory and hemodynamic status, antibiotic treatment was changed to cefiderocol monotherapy at 30 mg/kg/dose every 8 hours. Within 72 hours of commencing cefiderocol, the neonate was successfully extubated to variable-flow continuous positive airway pressure and showed ongoing clinical improvement.
Cefiderocol was integral for the care of our neonate without any immediate adverse safety consequences. We relied on dosing data from a conference abstract, due to the paucity of evidence on the use of novel antimicrobials. This lack of evidence is particularly concerning given preterm neonates are particularly vulnerable to infections with multidrug-resistant Gram-negative organisms due to their immature immune systems, prolonged hospital stay, repeated interventions and antimicrobial exposure.
呼吸机相关性肺炎（VAP）在早产儿中存在发病和死亡风险，尤其是在全球抗菌药物耐药性上升导致多重耐药革兰氏阴性菌感染的背景下。头孢地尔，一种亲铁头孢菌素，具有广泛的革兰氏阴性抗菌活性且可穿透中枢神经系统，用于治疗成人医院获得性肺炎或VAP。关于其在新生儿中的使用数据稀缺。
一名孕26 + 6周出生的女婴在出生21天时发生VAP。她开始接受皮质类固醇、万古霉素和头孢他啶治疗，但病情持续恶化。痰培养结果显示嗜麦芽窄食单胞菌对甲氧苄啶/磺胺甲恶唑、环丙沙星和头孢他啶耐药，对头孢地尔可能敏感。脑脊液显示白细胞计数升高。鉴于呼吸和血流动力学状况恶化，抗生素治疗改为每8小时30mg/kg剂量的头孢地尔单药治疗。在开始使用头孢地尔的72小时内，新生儿成功脱机至可变流量持续气道正压通气，并显示出持续的临床改善。
头孢地尔对我们的新生儿护理至关重要，且无任何直接不良安全后果。由于新型抗菌药物使用的证据匮乏，我们依赖于会议摘要中的给药数据。鉴于早产儿因其免疫系统不成熟、住院时间延长、反复干预和抗菌药物暴露而特别容易受到多重耐药革兰氏阴性菌感染，这种证据的缺乏尤其令人担忧。
