Clinical effectiveness of cefiderocol for the treatment of bloodstream infections due to carbapenem-resistant Acinetobacter baumannii during the COVID-19 era: a single center, observational study

Alessandra Oliva; L Liguori; S Covino; F Petrucci; F Cogliati-Dezza; A Curtolo; G Savelloni; M Comi; F Sacco; G Ceccarelli; A Viscido; F Alessandri; G Raponi; F Pugliese; C M Mastroianni; M Venditti

doi:10.1007/s10096-024-04833-8

Clinical effectiveness of cefiderocol for the treatment of bloodstream infections due to carbapenem-resistant Acinetobacter baumannii during the COVID-19 era: a single center, observational study

Eur J Clin Microbiol Infect Dis. 2024 Apr 18. doi: 10.1007/s10096-024-04833-8. Online ahead of print.

Authors

Alessandra Oliva¹, L Liguori², S Covino², F Petrucci², F Cogliati-Dezza², A Curtolo², G Savelloni², M Comi², F Sacco³, G Ceccarelli², A Viscido³, F Alessandri⁴, G Raponi³, F Pugliese⁴, C M Mastroianni², M Venditti²

Affiliations

¹ Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy. alessandra.oliva@uniroma1.it.
² Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome, 00185, Italy.
³ Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
⁴ Department of General and Specialistic Surgery, Sapienza University of Rome, Rome, Italy.

PMID: 38634975
DOI: 10.1007/s10096-024-04833-8

Abstract

Background: We assessed the clinical effectiveness of cefiderocol (CFDC) in comparison with colistin (COL) for the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infections (BSI).

Materials/methods: Retrospective cohort study including adults with CRAB-BSI. Outcomes were mortality, clinical cure and adverse events during therapy. The average treatment effect of CFDC compared to COL was weighted with the inverse-probability treatment weight (IPTW).

Results: Overall, 104 patients were included (50 CFDC, 54 COL), median age 66.5 years, median Charlson Comorbidity Index 5, septic shock in 33.6% of patients. Primary BSI accounted for 43.3% of cases, followed by ventilator-associated pneumonia (VAP) (26%), catheter-related BSI (20.2%) and hospital-acquired pneumonia (HAP) (9.6%). Although not significantly, mortality at all time points was lower for CFDC than COL, while clinical cure was higher in CFDC than COL (66% vs. 44.4%, p = 0.027). Adverse events were more frequent in COL than CFDC-group (38.8% vs. 10%, p < 0.0001), primarily attributed to acute kidney injury (AKI) in the COL group. Patients with bacteremic HAP/VAP treated with CFDC had a significant lower 30-d mortality and higher clinical cure than COL (p = 0.008 and p = 0.0008, respectively). Increment of CCI (p = 0.005), ICU (p = 0.025), SARS-CoV2 (p = 0.006) and ECMO (p < 0.0001) were independently associated with 30-d mortality, while receiving CFDC was not associated with survival.

Conclusions: CFDC could represent an effective and safe treatment option for CRAB BSI, especially in patients with bacteremic HAP/VAP and frail patients where the risk of acute renal failure during therapy should be avoided.

Keywords: Bloodstream infection; Carbapenem-resistant Acinetobacter baumannii; Cefiderocol; Colistin; Pneumonia; Ventilator-acquired pneumonia.