Vacheron Charles-Hervé, Kaas Anne, Rasigade Jean-Philippe, Aubrun Frederic, Argaud Laurent, Balanca Baptiste, Fellahi Jean-Luc, Richard Jean Christophe, Lukaszewicz Anne-Claire, Wallet Florent, Dauwalder Olivier, Friggeri Arnaud
Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.
CIRI-Centre International de Recherche en Infectiologie (Team PHE3ID), Univ Lyon, Université, Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR5308, ENS Lyon, 46 allée d'Italie, Lyon, 69007, France.
Ann Intensive Care. 2024 May 12;14(1):73. doi: 10.1186/s13613-024-01308-z.
The efficacy and safety of cefiderocol in ICU patients with difficult-to-treat resistance (DTR) non-fermenting Gram-negative bacteria (Nf-GNB) are not as well-established. Consequently, we conducted a cohort study to compare Cefiderocol with the Best Available Therapy (BAT) in ICU patients.
We included adult patients from 9 different ICUs, including a burn ICU unit, from 2019 to 2023 treated with Cefiderocol for DTR Nf-GNB isolated from the blood or lungs. We matched each patient at a 1:2 ratio based on the same DTR Nf-GBN isolated pathogen, and when possible, within the same type of ICU (burn unit or not). The primary endpoint of the study was the clinical cure at 15 days, with secondary endpoints including clinical cure at 30 days, relapse, and in-ICU mortality. For each outcome, adjusted odds ratios were estimated using bidirectional stepwise regression in a final model, which included 13 preselected confounders.
We included 27 patients with cefiderocol, matched with 54 patients receiving the BAT. Four patients were not exactly matched on the type of ICU unit. Characteristics were comparable between groups, mostly male with a Charlson Comorbidity Index of 3 [1-5], and 28% had immunosuppression. Cefiderocol patients were most likely to have higher number of antibiotic lines. The main DTR Nf-GNB identified was Pseudomonas aeruginosa (81.5%), followed by Acinetobater baumanii (14.8%) and Stenotrophomonas maltophilia (3.7%). Pneumonia was the identified infection in 21 (78.8%) patients in the Cefiderocol group and in 51 (94.4%) patients in the BAT group (p = 0.054). Clinical cure at 15 and 30-day and the in-ICU mortality was comparable between groups, however relapse was higher in the cefiderocol group (8-29.6% vs. 4-7.4%;aOR 10.06[1.96;51.53]) CONCLUSION: Cefiderocol did not show an improvement in clinical cure or mortality rates compared to BAT in the treatment of DTR Nf-GNB, but it was associated with a higher relapse rate.
头孢地尔对重症监护病房（ICU）中具有难治性耐药（DTR）的非发酵革兰氏阴性菌（Nf-GNB）患者的疗效和安全性尚未完全明确。因此，我们进行了一项队列研究，比较头孢地尔与ICU患者的最佳可用治疗（BAT）。
我们纳入了2019年至2023年期间来自9个不同ICU（包括一个烧伤ICU病房）的成年患者，这些患者因血液或肺部分离出的DTR Nf-GNB而接受头孢地尔治疗。我们根据相同的DTR Nf-GBN分离病原体，以1:2的比例为每位患者匹配，尽可能在同一类型的ICU（烧伤病房或非烧伤病房）内进行匹配。该研究的主要终点是15天时的临床治愈，次要终点包括30天时的临床治愈、复发和ICU内死亡率。对于每个结局，在最终模型中使用双向逐步回归估计调整后的优势比，该模型包括13个预先选定的混杂因素。
我们纳入了27例使用头孢地尔的患者，与54例接受BAT治疗的患者相匹配。有4例患者在ICU病房类型上不完全匹配。两组之间的特征具有可比性，大多数为男性，Charlson合并症指数为3[1-5]，28%的患者有免疫抑制。使用头孢地尔的患者最有可能使用更多种类的抗生素。鉴定出的主要DTR Nf-GNB是铜绿假单胞菌（81.5%），其次是鲍曼不动杆菌（14.8%）和嗜麦芽窄食单胞菌（3.7%）。头孢地尔组21例（78.8%）患者和BAT组51例（94.4%）患者被确定为肺炎感染（p = 0.054）。两组在15天和30天时的临床治愈情况以及ICU内死亡率相当，然而头孢地尔组的复发率更高（8-29.6%对4-7.4%；调整后的优势比10.06[1.96；51.53]）。结论：在治疗DTR Nf-GNB方面，与BAT相比，头孢地尔在临床治愈或死亡率方面未显示出改善，但它与更高的复发率相关。
