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Purpose <p>The global rise in infections due to multidrug-resistant Gram-negative bacteria (MDRGNB) infections has disproportionately impacted immunocompromised (IC) hosts. Cefiderocol, a novel siderophore cephalosporin, exhibits potent activity against MDRGNB, but limited data exist on its use in IC patients. This study aimed to describe cefiderocol use in IC patients.</p> Methods <p>Patients and therapy characteristics were descriptively reported, and outcomes were compared between IC and non-IC patients. Cox regression models were used to identify factors associated with mortality.</p> Results <p>Among 185 patients, 84 (45.4%) were IC. Similar descriptive rates were observed in IC and non-IC groups regarding indications for cefiderocol use, choice of monotherapy versus combination therapy, or empirical versus targeted treatment. The 28-day clinical cure rates were similar across patients receiving targeted cefiderocol therapy for infection due to <i>Pseudomonas aeruginosa</i> (81%, 17/21), Enterobacterales (77.3%, 17/22) and <i>Acinetobacter baumannii</i> (42%, 21/50). Thirty-day mortality was comparable between IC and non-IC patients (40.8%, 95% confidence interval [CI] 27.9–56.8 vs 33.3%, 95% CI 22.9–46.9; p = 0.5430). In multivariable analysis IC status was not associated with higher mortality.</p> Conclusion <p>Cefiderocol use in IC patients resulted in clinical outcomes comparable to non-IC patients when treating MDRGNB infections. IC status was not associated with an increased mortality, emphasising the importance of effective antimicrobial therapy. Further investigation is needed to clarify the relative impact of the administered treatment vs. the patients’ clinical condition in influencing the prognosis of <i>Acinetobacter baumannii</i> infections.</p>

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Cefiderocol therapy among immunocompromised adult patients: a descriptive analysis from a prospective, multicentre cohort study

  • 期刊论文

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  • 发表日期：

    2025年10月16日

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  • Andrea Lombardi,
  • Daniele Roberto Giacobbe,
  • Davide Mangioni,
  • Bianca Mariani,
  • Antonio Muscatello,
  • Marco Muccio,
  • Chiara Aldieri,
  • Federica Briano,
  • Bruno Cacopardo,
  • Alessandra Calabresi,
  • Federico Capra Marzani,
  • Anna Carretta,
  • Annamaria Cattelan,
  • Luca Ceccarelli,
  • Giovanni Cenderello,
  • Silvia Corcione,
  • Andrea Cortegiani,
  • Rosario Cultrera,
  • Francesco Giuseppe De Rosa,
  • Valerio Del Bono,
  • Filippo Del Puente,
  • Chiara Fanelli,
  • Fiorenza Fava,
  • Daniela Francisci,
  • Nicholas Geremia,
  • Lucia Graziani,
  • Angela Raffaella Losito,
  • Ivana Maida,
  • Andrea Marino,
  • Maria Mazzitelli,
  • Marco Merli,
  • Roberta Monardo,
  • Alessandra Mularoni,
  • Chiara Oltolini,
  • Carlo Pallotto,
  • Emanuele Pontali,
  • Francesca Raffaelli,
  • Matteo Rinaldi,
  • Marco Ripa,
  • Teresa Antonia Santantonio,
  • Francesco Saverio Serino,
  • Michele Spinicci,
  • Carlo Torti,
  • Enrico Maria Trecarichi,
  • Mario Tumbarello,
  • Malgorzata Mikulska,
  • Antonio Vena,
  • Alessandra Bandera,
  • Matteo Bassetti,
  • Cristina Marelli,
  • Vincenzo Di Pilato,
  • Alessio Signori,
  • Laura Labate,
  • Chiara Russo Artimagnella,
  • Mauro Giacomini,
  • Anna Marchese,
  • Ylenia Murgia,
  • Gabriele Di Meco,
  • Alice Cappello,
  • Sabrina Guastavino,
  • Cristina Campi,
  • Michele Piana,
  • Sara Mora,
  • Nicola Rosso,
  • Antonio Di Biagio,
  • Giulia Viglietti,
  • Iole Brunetti,
  • Chiara Robba,
  • Lorenzo Ball,
  • Denise Battaglini,
  • Federica Portunato,
  • Maddalena Giannella,
  • Pierluigi Viale,
  • Giulia Viero,
  • Cecilia Azzarà,
  • Paola Saltini,
  • Alessandro Bartoloni,
  • Benedetta Casciato,
  • Chiara Grillo,
  • Donatella Concetta Cibelli,
  • Silvia Boni,
  • Marcello Feasi,
  • Paola Del Giacomo,
  • Gianmaria Baldin,
  • Federico D’Amico,
  • Giovanna Travi,
  • Teresa Fasciana,
  • Giulia Catalisano,
  • Antonino Giarratano,
  • Elena Baranello,
  • Margherita Albagini,
  • Chiara Maci,
  • Antonella Castagna,
  • Cecilia Grosso,
  • Nour Shbaklo,
  • Elena Momesso,
  • Nicoletta Boffa,
  • Elena Potenza,
  • Vincenzo Scaglione,
  • Daniele Mengato,
  • Alessandro Russo,
  • Ludovica Corsello,
  • Francesca Serapide,
  • Monica Rizzo,
  • Erika Asperges,
  • Francesco Truffelli,
  • Margherita Sambo,
  • Gabriele Giuliano,
  • Francesco Fele,
  • Chiara Gullotta,
  • Edoardo Campanella,
  • Maria Chiara Meloni,
  • Sabrina Boraso,
  • Sandro Panese,
  • Aurora Bonazza,
  • Kristian Scolz,
  • Erika Coppo,
  • Marco Berruti

摘要

Purpose

The global rise in infections due to multidrug-resistant Gram-negative bacteria (MDRGNB) infections has disproportionately impacted immunocompromised (IC) hosts. Cefiderocol, a novel siderophore cephalosporin, exhibits potent activity against MDRGNB, but limited data exist on its use in IC patients. This study aimed to describe cefiderocol use in IC patients.

Methods

Patients and therapy characteristics were descriptively reported, and outcomes were compared between IC and non-IC patients. Cox regression models were used to identify factors associated with mortality.

Results

Among 185 patients, 84 (45.4%) were IC. Similar descriptive rates were observed in IC and non-IC groups regarding indications for cefiderocol use, choice of monotherapy versus combination therapy, or empirical versus targeted treatment. The 28-day clinical cure rates were similar across patients receiving targeted cefiderocol therapy for infection due to Pseudomonas aeruginosa (81%, 17/21), Enterobacterales (77.3%, 17/22) and Acinetobacter baumannii (42%, 21/50). Thirty-day mortality was comparable between IC and non-IC patients (40.8%, 95% confidence interval [CI] 27.9–56.8 vs 33.3%, 95% CI 22.9–46.9; p = 0.5430). In multivariable analysis IC status was not associated with higher mortality.

Conclusion

Cefiderocol use in IC patients resulted in clinical outcomes comparable to non-IC patients when treating MDRGNB infections. IC status was not associated with an increased mortality, emphasising the importance of effective antimicrobial therapy. Further investigation is needed to clarify the relative impact of the administered treatment vs. the patients’ clinical condition in influencing the prognosis of Acinetobacter baumannii infections.