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.

Details

Title
Cefiderocol treatment for carbapenem-resistant Acinetobacter baumannii infection in the ICU during the COVID-19 pandemic: a multicentre cohort study
Author
Pascale, Renato 1 ; Pasquini, Zeno 1 ; Bartoletti, Michele 1 ; Caiazzo, Luca 2 ; Fornaro, Giacomo 1 ; Bussini, Linda 1 ; Volpato, Francesca 1 ; Marchionni, Elisa 1 ; Rinaldi, Matteo 1   VIAFID ORCID Logo  ; Trapani, Filippo 1 ; Temperoni, Chiara 2 ; Gaibani, Paolo 3   VIAFID ORCID Logo  ; Ambretti, Simone 3 ; Barchiesi, Francesco 4 ; Viale, Pierluigi 1 ; Giannella, Maddalena 1 

1  Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant’Orsola, Bologna, Italy 
2  Infectious Disease Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy 
3  Operative Unit of Microbiology, University of Bologna, Policlinico Sant’Orsola, Bologna, Italy 
4  Infectious Disease Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy; Department of Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy 
Publication year
2021
Publication date
Dec 2021
Publisher
Oxford University Press
e-ISSN
26321823
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/jacamr/dlab174
ProQuest document ID
3169987479
Copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. This work is published under https://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.