Giacobbe Daniele Roberto, Labate Laura, Russo Artimagnella Chiara, Marelli Cristina, Signori Alessio, Di Pilato Vincenzo, Aldieri Chiara, Bandera Alessandra, Briano Federica, Cacopardo Bruno, Calabresi Alessandra, Capra Marzani Federico, Carretta Anna, Cattelan Annamaria, Ceccarelli Luca, Cenderello Giovanni, Corcione Silvia, Cortegiani Andrea, Cultrera Rosario, De Rosa Francesco Giuseppe, Del Bono Valerio, Del Puente Filippo, Fanelli Chiara, Fava Fiorenza, Francisci Daniela, Geremia Nicholas, Graziani Lucia, Lombardi Andrea, Losito Angela Raffaella, Maida Ivana, Marino Andrea, Mazzitelli Maria, Merli Marco, Monardo Roberta, Mularoni Alessandra, Oltolini Chiara, Pallotto Carlo, Pontali Emanuele, Raffaelli Francesca, Rinaldi Matteo, Ripa Marco, Santantonio Teresa Antonia, Serino Francesco Saverio, Spinicci Michele, Torti Carlo, Trecarichi Enrico Maria, Tumbarello Mario, Mikulska Malgorzata, Giacomini Mauro, Marchese Anna, Vena Antonio, Bassetti Matteo
Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi, 10, 16132, Genoa, Italy.
Infect Dis Ther. 2024 Sep;13(9):1929-1948. doi: 10.1007/s40121-024-01016-y. Epub 2024 Jul 12.
Cefiderocol is a siderophore cephalosporin showing activity against various carbapenem-resistant Gram-negative bacteria (CR-GNB). No data currently exist about real-world use of cefiderocol in terms of types of therapy (e.g., empirical or targeted, monotherapy or combined regimens), indications, and patient characteristics.
In this multicenter, prospective study, we aimed at describing the use of cefiderocol in terms of types of therapy, indications, and patient characteristics.
Cefiderocol was administered as empirical and targeted therapy in 27.5% (55/200) and 72.5% (145/200) of cases, respectively. Overall, it was administered as monotherapy in 101/200 cases (50.5%) and as part of a combined regimen for CR-GNB infections in the remaining 99/200 cases (49.5%). In multivariable analysis, previous isolation of carbapenem-resistant Acinetobacter baumannii odds ratio (OR) 2.56, with 95% confidence interval (95% CI) 1.01-6.46, p = 0.047] and previous hematopoietic stem cell transplantation (OR 8.73, 95% CI 1.05-72.54, p = 0.045) were associated with administration of cefiderocol as part of a combined regimen, whereas chronic kidney disease was associated with cefiderocol monotherapy (OR 0.38 for combined regimen, 95% CI 0.16-0.91, p = 0.029). Cumulative 30-day mortality was 19.8%, 45.0%, 20.7%, and 22.7% in patients receiving targeted cefiderocol for infections by Enterobacterales, A. baumannii, Pseudomonas aeruginosa, and any metallo-β-lactamase producers, respectively.
Cefiderocol is mainly used for targeted treatment, although empirical therapies account for more than 25% of prescriptions, thus requiring dedicated standardization and guidance. The almost equal distribution of cefiderocol monotherapy and cefiderocol-based combination therapies underlines the need for further study to ascertain possible differences in efficacy between the two approaches.
头孢地尔是一种铁载体头孢菌素，对多种耐碳青霉烯革兰氏阴性菌（CR-GNB）具有活性。目前尚无关于头孢地尔在实际应用中治疗类型（如经验性或靶向性、单药治疗或联合治疗方案）、适应症和患者特征的数据。
在这项多中心前瞻性研究中，我们旨在描述头孢地尔在治疗类型、适应症和患者特征方面的应用情况。
头孢地尔分别在27.5%（55/200）和72.5%（145/200）的病例中作为经验性治疗和靶向性治疗使用。总体而言，它在101/200例（50.5%）病例中作为单药治疗使用，在其余99/200例（49.5%）病例中作为CR-GNB感染联合治疗方案的一部分使用。在多变量分析中，既往分离出耐碳青霉烯鲍曼不动杆菌的比值比（OR）为2.56，95%置信区间（95%CI）为1.01-6.46，p = 0.047]以及既往进行造血干细胞移植（OR 8.73，95%CI 1.05-72.54，p = 0.045）与作为联合治疗方案一部分使用头孢地尔相关，而慢性肾脏病与头孢地尔单药治疗相关（联合治疗方案的OR为0.38，95%CI为0.16-0.91，p = 0.029）。接受靶向性头孢地尔治疗的肠杆菌科细菌、鲍曼不动杆菌、铜绿假单胞菌和任何产金属β-内酰胺酶菌感染患者的30天累积死亡率分别为19.8%、45.0%、20.7%和22.7%。
头孢地尔主要用于靶向治疗，尽管经验性治疗占处方的25%以上，因此需要专门的标准化和指导。头孢地尔单药治疗和基于头孢地尔的联合治疗近乎均等的分布凸显了进一步研究以确定两种方法在疗效上可能存在差异的必要性。
