Cefiderocol treatment for carbapenem-resistant Acinetobacter baumannii infection in the ICU during the COVID-19 pandemic: a multicentre cohort study

JAC-Antimicrobial Resistance - Tập 3 Số 4 - 2021
Renato Pascale1, Zeno Pasquini1, Michele Bartoletti1, Luca Caiazzo2, Giacomo Fornaro1, Linda Bussini1, Francesca Volpato1, Elisa Marchionni1, Matteo Rinaldi1, Filippo Trapani1, Chiara Temperoni2, Paolo Gaibani3, Simone Ambretti3, Francesco Barchiesi4,2, Pierluigi Viale1, Maddalena Giannella1
1Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant’Orsola, Bologna, Italy
2Infectious Disease Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
3Operative Unit of Microbiology, University of Bologna, Policlinico Sant’Orsola, Bologna, Italy
4Department of Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy

Tóm tắt

Abstract Objectives To analyse the impact of cefiderocol use on outcome in patients admitted to the ICU for severe COVID-19 and further diagnosed with carbapenem-resistant Acinetobacter baumannii (CR-Ab) infection. Methods Retrospective multicentre observational study was performed at four Italian hospitals, from January 2020 to April 2021. Adult patients admitted to ICU for severe COVID-19 and further diagnosed with CR-Ab infections were enrolled. Patients treated with cefiderocol, as compassionate use, for at least 72 h were compared with those receiving alternative regimens. Primary endpoint was all-cause 28 day mortality. The impact of cefiderocol on mortality was evaluated by multivariable Cox regression model. Results In total, 107 patients were enrolled (76% male, median age 65 years). The median time from ICU admission to CR-Ab infection diagnosis was 14 (IQR 8–20) days, and the main types of CR-Ab infections were bloodstream infection (58%) and lower respiratory tract infection (41%). Cefiderocol was administered to 42 patients within a median of 2 (IQR 1–4) days after CR-Ab infection diagnosis and as monotherapy in all cases. The remaining patients received colistin, mostly (82%) administered as combination therapy. All-cause 28 day mortality rate was 57%, without differences between groups (cefiderocol 55% versus colistin 58% P = 0.70). In multivariable analysis, the independent risk factor for mortality was SOFA score (HR 1.24, 95% CI 1.15–1.38, P < 0.001). Cefiderocol was associated with a non-significant lower mortality risk (HR 0.64, 95% CI 0.38–1.08, P = 0.10). Conclusions Our study confirms the potential role of cefiderocol in the treatment of CR-Ab infection, but larger clinical studies are needed.

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JAC-Antimicrobial Resistance

Tập 3 Số 4

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