Outcome of patients with carbapenem-resistant Acinetobacter baumannii infections treated with cefiderocol: A multicenter observational study.
A. baumannii
Carbapenem-resistant
Cefiderocol
Clinical failure
Microbiological failure
Mortality
Journal
Journal of infection and public health
ISSN: 1876-035X
Titre abrégé: J Infect Public Health
Pays: England
ID NLM: 101487384
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
received:
28
03
2023
revised:
15
05
2023
accepted:
11
06
2023
medline:
11
8
2023
pubmed:
23
6
2023
entrez:
22
6
2023
Statut:
ppublish
Résumé
No clear evidence supports the use of cefiderocol as first line treatment in A. baumannii infections. We conducted an observational retrospective/prospective multicenter study including all patients> 18 years with carbapenem-resistant A. baumannii (CRAB) infections treated with cefiderocol, from June 12021 to October 30 2022. Primary endpoint was 30-day mortality, secondary end-points the clinical and microbiological response at 7 days and at the end of treatment. Furthermore, we compared the clinical and microbiological outcomes among patients who received cefiderocol in monotherapy or in combination. Thirty-eight patients with forty episodes of infection were included [mean age 65 years (SD+16.3), 75% males, 90% with hospital-acquired infections and 70% showing sepsis or septic shock]. The most common infections included unknown source or catheter-related bacteremia (45%) and pneumonia (40%). We observed at 7 days and at the end of therapy a rate of microbiological failure of 20% and 10%, respectively, and of clinical failure of 47.5% and 32.5%, respectively; the 30-day mortality rate was 47.5%. At multivariate analysis clinical failure at 7 days of treatment was the only independent predictor of 30-day mortality. Comparing monotherapy (used in 72.5%) vs. combination therapy (used in 27.5%), no differences were observed in mortality (51.7 vs 45.5%) and clinical (41.4 vs 63.7%) or microbiological failure (24.1 vs 9.1%). The findings of this study reinforce the effectiveness of cefiderocol in CRAB infections, also as monotherapy. However, prospective multicenter studies with larger sample sizes and a control group treated with standard of care are needed to identify the best treatment for CRAB infections.
Sections du résumé
BACKGROUND
BACKGROUND
No clear evidence supports the use of cefiderocol as first line treatment in A. baumannii infections.
METHODS
METHODS
We conducted an observational retrospective/prospective multicenter study including all patients> 18 years with carbapenem-resistant A. baumannii (CRAB) infections treated with cefiderocol, from June 12021 to October 30 2022. Primary endpoint was 30-day mortality, secondary end-points the clinical and microbiological response at 7 days and at the end of treatment. Furthermore, we compared the clinical and microbiological outcomes among patients who received cefiderocol in monotherapy or in combination.
RESULTS
RESULTS
Thirty-eight patients with forty episodes of infection were included [mean age 65 years (SD+16.3), 75% males, 90% with hospital-acquired infections and 70% showing sepsis or septic shock]. The most common infections included unknown source or catheter-related bacteremia (45%) and pneumonia (40%). We observed at 7 days and at the end of therapy a rate of microbiological failure of 20% and 10%, respectively, and of clinical failure of 47.5% and 32.5%, respectively; the 30-day mortality rate was 47.5%. At multivariate analysis clinical failure at 7 days of treatment was the only independent predictor of 30-day mortality. Comparing monotherapy (used in 72.5%) vs. combination therapy (used in 27.5%), no differences were observed in mortality (51.7 vs 45.5%) and clinical (41.4 vs 63.7%) or microbiological failure (24.1 vs 9.1%).
CONCLUSIONS
CONCLUSIONS
The findings of this study reinforce the effectiveness of cefiderocol in CRAB infections, also as monotherapy. However, prospective multicenter studies with larger sample sizes and a control group treated with standard of care are needed to identify the best treatment for CRAB infections.
Identifiants
pubmed: 37349243
pii: S1876-0341(23)00215-0
doi: 10.1016/j.jiph.2023.06.009
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Carbapenems
0
Types de publication
Multicenter Study
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1485-1491Informations de copyright
Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest All the authors declare that they have no conflict of interest with the present paper, Outcome of patients with Carbapenem-Resistant Acinetobacter baumannii infections treated with cefiderocol: a multicenter observational study.