Ferrara Francesco, Martellone Lorenzo, Vaccaro Marcello, Coluccia Adriana, Scognamiglio Manlio, Langella Roberto, Zovi Andrea, Polito Giacomo
Pharmaceutical Department, Asl Napoli 3 Sud, Naples, Italy.
Department of Chemistry and Pharmaceutical Technologies, University of Rome "La Sapienza", Rome, Italy.
Eur J Clin Pharmacol. 2025 Jun 12. doi: 10.1007/s00228-025-03866-y.
Healthcare-associated infections (HAIs) represent one of the most serious complications in medical care, with a substantial global burden. The emergence and spread of antibiotic resistance, particularly among multidrug-resistant organisms such as carbapenem-resistant Acinetobacter baumannii (CRAb), have significantly complicated infection management.
The aim of this review is to provide an updated perspective on its clinical use and to explore novel therapeutic strategies for combating multidrug-resistant bacterial infections.
A narrative review was performed in accordance with PRISMA 2020 guidelines, including real-world, comparative, and longitudinal observational studies that assessed cefiderocol efficacy, safety, and associated clinical outcomes.
The findings suggest that cefiderocol is a promising therapeutic agent for CRAb infections, demonstrating lower mortality rates compared to colistin-based regimens. Comparative studies also report a superior safety profile, particularly regarding reduced nephrotoxicity. Cefiderocol unique siderophore-mediated mechanism facilitates efficient bacterial uptake, enabling activity even against carbapenem-resistant strains.
Although emerging evidence supports cefiderocol efficacy and safety, concerns persist about the potential for resistance development. Further randomized controlled trials are needed to clarify its role in the daily clinical practice and establish definitive treatment guidelines. In this context, the inclusion of reference intervals for resistance emergence during therapy is recommended, underscoring the need for vigilant monitoring throughout treatment.
医疗保健相关感染（HAIs）是医疗中最严重的并发症之一，在全球造成了沉重负担。抗生素耐药性的出现和传播，尤其是在碳青霉烯耐药鲍曼不动杆菌（CRAb）等多重耐药菌中，使感染管理变得极为复杂。
本综述旨在提供关于其临床应用的最新观点，并探索对抗多重耐药细菌感染的新治疗策略。
根据PRISMA 2020指南进行叙述性综述，纳入评估头孢地尔疗效、安全性及相关临床结局的真实世界研究、比较研究和纵向观察性研究。
研究结果表明，头孢地尔是治疗CRAb感染的一种有前景的治疗药物，与基于黏菌素的治疗方案相比，死亡率更低。比较研究还报告了更好的安全性，尤其是肾毒性降低。头孢地尔独特的铁载体介导机制有助于细菌有效摄取，使其即使对碳青霉烯耐药菌株也具有活性。
尽管新出现的证据支持头孢地尔的疗效和安全性，但对耐药性产生的可能性仍存在担忧。需要进一步的随机对照试验来阐明其在日常临床实践中的作用，并建立明确的治疗指南。在此背景下，建议纳入治疗期间耐药性出现的参考区间，强调在整个治疗过程中进行密切监测的必要性。
