Cefiderocol Treatment for Severe Infections due to Difficult-to-Treat-Resistant Non-Fermentative Gram-Negative Bacilli in ICU Patients: A Case Series and Narrative Literature Review
Paul-Henri Wicky,
Joséphine Poiraud,
Manuel Alves,
Juliette Patrier,
Camille d’Humières,
Minh Lê,
Laura Kramer,
Étienne de Montmollin,
Laurent Massias,
Laurence Armand-Lefèvre,
Jean-François Timsit
Affiliations
Paul-Henri Wicky
Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Cité University, F-75018 Paris, France
Joséphine Poiraud
IAME INSERM UMR 1137, Paris Cité University, F-75018 Paris, France
Manuel Alves
IAME INSERM UMR 1137, Paris Cité University, F-75018 Paris, France
Juliette Patrier
Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Cité University, F-75018 Paris, France
Camille d’Humières
IAME INSERM UMR 1137, Paris Cité University, F-75018 Paris, France
Minh Lê
IAME INSERM UMR 1137, Paris Cité University, F-75018 Paris, France
Laura Kramer
Pharmacy, AP-HP, Bichat Hospital, Paris Cité University, F-75018 Paris, France
Étienne de Montmollin
Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Cité University, F-75018 Paris, France
Laurent Massias
IAME INSERM UMR 1137, Paris Cité University, F-75018 Paris, France
Laurence Armand-Lefèvre
IAME INSERM UMR 1137, Paris Cité University, F-75018 Paris, France
Jean-François Timsit
Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat Hospital, Paris Cité University, F-75018 Paris, France
Cefiderocol (FDC) is a siderophore cephalosporin now recognized as a new weapon in the treatment of difficult-to-treat-resistant (DTR) Gram-negative pathogens, including carbapenemase-producing enterobacterales and non-fermentative Gram-negative bacilli (GNB). This article reports our experience with an FDC-based regimen in the treatment of 16 extremely severe patients (invasive mechanical ventilation, 15/16; extracorporeal membrane oxygenation, 9/16; and renal replacement therapy, 8/16) infected with DTR GNB. Our case series provides detailed insight into the pharmacokinetic profile and the microbiological data in real-life conditions. In the narrative review, we discuss the interest of FDC in the treatment of non-fermentative GNB in critically ill patients. We reviewed the microbiological spectrum, resistance mechanisms, pharmacokinetics/pharmacodynamics, efficacy and safety profiles, and real-world evidence for FDC. On the basis of our experience and the available literature, we discuss the optimal FDC-based regimen, FDC dosage, and duration of therapy in critically ill patients with DTR non-fermentative GNB infections.
