Real-world multicentre study of cefiderocol treatment of immunocompromised patients with infections caused by multidrug-resistant Gram-negative bacteria: CEFI-ID

被引:2
作者
Soueges, Sarah [1 ]
Faure, Emmanuel [2 ]
Parize, Perrine [3 ]
Lanternier-Dessap, Fanny [3 ]
Lecuyer, Herve [4 ]
Huynh, Anne [5 ]
Martin-Blondel, Guillaume [6 ,7 ]
Gaborit, Benjamin [8 ]
Blot, Mathieu [9 ]
Magallon, Arnaud [10 ]
Blanchard, Elodie [11 ]
Brousse, Xavier [12 ]
Lahouati, Marin [13 ,14 ,15 ,16 ]
Brunel, Anne-Sophie [17 ]
Le Banner, Eloise [18 ]
Camelena, Francois [19 ]
Larcher, Romaric [20 ]
Pantel, Alix [21 ]
Melica, Giovanna [22 ]
Razazi, Keyvan [22 ,23 ]
Danion, Francois [24 ]
Schramm, Frederic [25 ]
Dumitrescu, Oana [26 ]
Hoellinger, Baptiste [24 ]
Ader, Florence [1 ,27 ]
机构
[1] Hosp Civils Lyon, Dept Malad Infect & Trop, F-69004 Lyon, France
[2] CHU Lille, Serv Univ Maladies Infect, Lille, France
[3] Univ Paris Cite, AP HP, Grp Hosp AP HP Ctr, Serv Malad Infect & Trop, Paris, France
[4] Univ Paris 05, Hop Necker Enfants Malad, AP HP, Biochim Lab, Paris, France
[5] CHU Inst Univ Canc Toulouse, Oncopole, Toulouse, France
[6] Univ Toulouse III, Toulouse Inst Infect & Inflammat Dis Infin, INSERM UMR1291, CNRS UMR5051, F-31024 Toulouse, France
[7] Ctr Hosp Univ Toulouse, Serv Malad Infect & Trop, Toulouse, France
[8] Serv Malad Infectieuses & Trop, Serv Malad Infect & Trop, Nantes, France
[9] Univ Bourgogne, CHU Dijon Bourgogne, Dept Maladies Infect, Dijon, France
[10] Univ Bourgogne, Ctr Hosp Univ Dijon Bourgogne, Dept Bacteriol, Bourgogne, France
[11] CHU Bordeaux, Serv Pneumol, Bordeaux, France
[12] CHU Bordeaux, Hop Pellegrin, Serv Malad Infect & Trop, Bordeaux, France
[13] Univ Bordeaux, INSERM U1034, Biol Malad Cardiovasc, Pessac, France
[14] CHU Bordeaux, Hop Pellegrin, Serv Pharm Clin, Bordeaux, France
[15] CHU Bordeaux, Serv Pharm Clin, INSERM U1034, Biol Malad Cardiovasc, Bordeaux, France
[16] Biol Malad Cardiovasc, INSERM U1034, Pessac, France
[17] Ctr Hosp Reg Univ, Malad Infect & Trop, Serv Malad Infect & Trop, Chambery, France
[18] CHU Rennes, Hop Pontchaillou, Serv Malad Infect & Reanimat Med, Rennes, France
[19] Grp Hosp St Louis Lariboisiere, Assistance Publ Hop Paris AP HP, Dept Bacteriol, Paris, France
[20] CHU Nimes, Dept Malad Infect & Trop, F-30000 Nimes, France
[21] CHU Nimes, CHU Nimes, Dept Microbiol & Hyg Hosp, Nimes, France
[22] Univ Paris Est Creteil, Hop Univ Henri Mondor, AP HP, Dept Malad Infect & Immunol, Creteil, France
[23] Hop Univ Henri Mondor, Assistance Publ Hop Paris AP HP, Serv Chirurg Vasc, DMU Med, F-94010 Creteil, France
[24] Hop Univ Strasbourg, Dept Malad Infect & Trop, Strasbourg, France
[25] Hop Univ Strasbourg, Lab Bacteriol, Strasbourg, France
[26] Hosp Civils Lyon, Lab Bacteriol, F-69004 Lyon, France
[27] Univ Claude Bernard Lyon 1, Univ Lyon, Ecole Normale Super Lyon, Ctr Int Rech Infectiol CIRI,Inserm U1111,CNRS UMR5, F-69007 Lyon, France
关键词
Cefiderocol; Immunocompromised patients; Stenotrophomonas maltophilia; Multi drug resistant gram-negative bacteria;
D O I
10.1016/j.jinf.2024.106376
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
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. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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