Real-world multicentre study of cefiderocol treatment of immunocompromised patients with infections caused by multidrug-resistant Gram-negative bacteria: CEFI-ID - 03/01/25
, Emmanuel Faure b, Perrine Parize c, Fanny Lanternier-Dessap c, Hervé Lecuyer d, Anne Huynh e, Guillaume Martin-Blondel f, g, Benjamin Gaborit h, Mathieu Blot i, Arnaud Magallon j, Elodie Blanchard k, Xavier Brousse l, Marin Lahouati m, n, Anne-Sophie Brunel o, Eloise Le Banner p, François Camelena q, Romaric Larcher r, Alix Pantel s, Giovanna Melica t, Keyvan Razazi u, François Danion v, Frederic Schramm w, Oana Dumitrescu x, Baptiste Hoellinger v, Florence Ader a, yOn behalf of the G2I (Groupe Immunodepression et Infections) network1
Summary |
Introduction |
The increase in the population of immunocompromised patients due to advances in management of end-stage diseases and transplants poses challenges in treating infections caused by multi-drug resistant (MDR) pathogens. Cefiderocol (FDC), a siderophore cephalosporin, has shown efficacy against carbapenem-resistant Gram-negative bacteria.
Methods |
This retrospective multicentre study investigated the real-world use of FDC in 114 immunocompromised adults treated for MDR infections in 12 French hospitals (June 2020–November 2023). Clinical and microbiological outcomes, including infection cure, relapse, as well as mortality, and resistance acquisition, were assessed at days 28 and 90. Antibiotic prescription compliance with current guidelines was investigated.
Results |
At day 28, clinical success was achieved in 53.3% of cases, and overall mortality was 37.7%, consistent with other studies (33–37%). Infection-related mortality accounted for 25.4%. Relapse occurred in 17.5% of patients by day 28, rising by an additional 9.8% among survivors by day 90. Resistance acquisition was observed in two cases at day 28 (Pseudomonas aeruginosa and Stenotrophomonas maltophilia) and in three additional cases by day 90. FDC was used as monotherapy in 49.1% of cases, with a median treatment duration of 10 days. Nearly 25% of strains collected in FDC-treated patients were susceptible to best-practice alternatives.
Conclusion |
These findings highlight FDC’s utility in difficult-to-treat infections, particularly S. maltophilia, but the high relapse rate and resistance acquisition underscore the need for careful monitoring, adherence to guidelines, and reconsideration of empirical use to prevent resistance and improve outcomes in fragile populations.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Few data are available on the use of cefiderocol in immunocompromised patients. |
• | Clinical success and overall mortality were similar to those of the general population. |
• | Relapses were frequent as well as resistance acquisition. |
• | The results confirm real-world efficacy of cefiderocol in S. matlophilia infections. |
Keywords : Cefiderocol, Immunocompromised patients, Stenotrophomonas maltophilia, Multi drug resistant gram-negative bacteria
Plan
Vol 90 - N° 1
Article 106376- janvier 2025 Retour au numéro
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