Marino Andrea, Venanzi Rullo Emmanuele, Russotto Ylenia, Visicaro Marco, Micali Cristina, Coco Mariagiovanna, Campanella Antonio Edoardo, Pellicanò Giovanni Francesco, Iacobello Carmelo, Nunnari Giuseppe
Department of Clinical and Experimental Medicine, University of Catania, I-95123 Catania, Italy.
Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, I-98122 Messina, Italy.
Biomed Rep. 2025 Jul 22;23(4):156. doi: 10.3892/br.2025.2034. eCollection 2025 Oct.
The increasing prevalence of multidrug-resistant (MDR) Gram-negative bacteria, particularly (), represents a major clinical challenge, especially in critically ill patients. Cefiderocol, a siderophore cephalosporin, has emerged as a promising therapeutic option for infections caused by carbapenem-resistant organisms. The present study aimed to evaluate the real-life efficacy and safety of cefiderocol in a high-risk hospital population. A monocentric, retrospective observational study was conducted at the University Hospital 'Gaetano Martino' in Messina, Italy, from July 2021 to April 2022. Adult patients treated with cefiderocol for ≥48 h for documented or suspected infections caused by MDR Gram-negative bacteria were included. Primary endpoints were clinical resolution and mortality at discharge. Secondary outcomes included adverse drug reactions, hospital epidemiology of MDR organisms, and correlation with colonization status. Data were analyzed using descriptive and inferential statistics. A total of 55 patients were included, with a median age of 65 years; 67.3% were male. Most infections were pneumonia (80.0%) and bloodstream infections (BSI; 45.5%). was the most frequently isolated pathogen (87.3%), with 73.7% being extensively drug-resistant. Clinical success was observed in 40% of ventilator-associated pneumonia, 66.7% of BSI, and 100% of skin and soft tissue infections. Overall mortality was 47.3%, significantly associated with colonization by MDR organisms (P=0.028) and septic shock (P=0.001). No serious adverse events related to cefiderocol were reported. In conclusion, in a real-world setting involving severely ill patients with limited therapeutic options, cefiderocol showed favorable efficacy and favorable tolerability, particularly in bloodstream and soft tissue infections. These results support its role as a valuable treatment option for MDR Gram-negative infections, especially in intensive care unit settings, although further controlled studies are warranted.
多重耐药（MDR）革兰氏阴性菌的患病率不断上升，尤其是（），这是一个重大的临床挑战，在重症患者中尤为突出。头孢地尔，一种铁载体头孢菌素，已成为治疗耐碳青霉烯类病原体引起的感染的一种有前景的治疗选择。本研究旨在评估头孢地尔在高危医院人群中的实际疗效和安全性。2021年7月至2022年4月在意大利墨西拿的“加埃塔诺·马尔蒂诺”大学医院进行了一项单中心回顾性观察研究。纳入了因记录在案或疑似由MDR革兰氏阴性菌引起的感染而接受头孢地尔治疗≥48小时的成年患者。主要终点是临床缓解和出院时的死亡率。次要结局包括药物不良反应、MDR病原体的医院流行病学以及与定植状态的相关性。使用描述性和推断性统计分析数据。共纳入55例患者，中位年龄65岁；67.3%为男性。大多数感染为肺炎（80.0%）和血流感染（BSI；45.5%）。（）是最常分离出的病原体（87.3%），其中73.7%为广泛耐药。在40%的呼吸机相关性肺炎、66.7%的BSI和100%的皮肤和软组织感染中观察到临床成功。总体死亡率为47.3%，与MDR病原体定植（P=0.028）和感染性休克（P=0.001）显著相关。未报告与头孢地尔相关的严重不良事件。总之，在涉及治疗选择有限的重症患者的现实环境中，头孢地尔显示出良好的疗效和耐受性，特别是在血流和软组织感染中。这些结果支持其作为MDR革兰氏阴性感染的有价值治疗选择的作用，尤其是在重症监护病房环境中，尽管需要进一步的对照研究。
