Successful Use of Cefiderocol to Treat a Multidrug-resistant Stenotrophomonas maltophilia Ventilator-associated Pneumonia in an Extremely Preterm Neonate

Archana Koirala; Bharath Krishnappa; Caroline Banh; Ulrike Brandenburg; Michael Findlay; Phoebe C M Williams

doi:10.1097/INF.0000000000004051

Successful Use of Cefiderocol to Treat a Multidrug-resistant Stenotrophomonas maltophilia Ventilator-associated Pneumonia in an Extremely Preterm Neonate

Pediatr Infect Dis J. 2023 Nov 1;42(11):1012-1016. doi: 10.1097/INF.0000000000004051. Epub 2023 Jul 24.

Authors

Archana Koirala^{1

2

3

4}, Bharath Krishnappa⁵, Caroline Banh^{1

6}, Ulrike Brandenburg⁵, Michael Findlay^{1

6}, Phoebe C M Williams^{2

3

4

7}

Affiliations

¹ From the Department of Infectious Diseases, Nepean Hospital, Kingswood, New South Wales, Australia.
² National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia.
³ School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
⁴ Sydney Infectious Diseases Institute, The University of Sydney, Sydney, New South Wales, Australia.
⁵ Department of Neonatal Services, Nepean Hospital, Kingswood, New South Wales, Australia.
⁶ Department of Microbiology, New South Wales Health Pathology, Kingswood, New South Wales, Australia.
⁷ Department of Infectious Diseases, Sydney Children Hospital, New South Wales, Australia.

PMID: 37523574
DOI: 10.1097/INF.0000000000004051

Abstract

Background: 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.

Case: 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.

Conclusions: 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.