Carbapenem-Resistant Acinetobacter spp Infection in Critically Ill Patients With Limited Treatment Options: A Descriptive Study of Cefiderocol Therapy During the COVID-19 Pandemic
Author:
Giannella Maddalena12ORCID, Verardi Stefano3, Karas Andreas3, Abdel Hadi Hasania4, Dupont Hervé5, Soriano Alex67, Santerre Henriksen Anne3, Cooper Andrew8, Falcone Marco9ORCID, Viale Pierluigi, Giannella Maddalena, Pascale Renato, Falcone Marco, Tiseo Giusy, Bandera Alessandra, Muheberimana Toussaint, Pastore Valeria, Saracino Alessandra, Bavaro Davide Fiore, Dalfino Lidia, Guerra Luca, Barchiesi Francesco, Farinaccio Ylenia, Temperoni Chiara, Parruti Giustino, Coladonato Simona, Rapacchiale Giorgia, Ferraris Laurenzia, Meloni Alessandro, Bruni Andrea, Garofalo Eugenio, Torti Carlo, Grossi Paolo, Mangoni Emanuele Durante, Massa Alessia, D’Amico Fabiana, Iossa Domenico, Karruli Arta, Carannante Novella, Merli Marco, Pallotto Carlo, Seminari Elena Maria, Sottotetti Samantha, Carbone Roberto, Casolari Stefania, Vanino Elisa, Cristini Francesco, Raumer Luigi, De Pascale Gennaro, di Chiaro Agnese, Cubattoli Lucia, Bartoloni Alessandro, Lauria Nicoletta Di, Venditti Mario, Oliva Alessandra, Cultrera Rosario, Hadi Hasania Abdel, Tenorio Carmen Hidalgo, Torres David Pérez, Canas-Pérez Isabel, Lorente Luis López-Urrutia, Rodriguez Montserrat, Balandin Barbara, Lepeule Raphaël, Wichmann Dominic, König Christina, Jarczak Dominik,
Affiliation:
1. Infectious Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico - Policlinico di Sant'Orsola , Bologna , Italy 2. Department of Medical and Surgical Sciences, University of Bologna , Bologna , Italy 3. Medical Affairs, Shionogi B.V. , London , United Kingdom 4. Unidad de Cuidados Intensivos, Hospital General Universitario , Ciudad Real , Spain 5. Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire d’Amiens Picardie , Amiens , France 6. Department of Infectious Diseases, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer , Barcelona , Spain 7. Centro de Investigación Biomédica en Red de Enfermedades Infecciosas , Barcelona , Spain 8. Global Epidemiology and Real-World Evidence, Shionogi B.V. , London , United Kingdom 9. Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa , Pisa , Italy
Abstract
Abstract
Background
Carbapenem-resistant Acinetobacter baumannii infections are difficult to treat and are a significant public health threat due to intrinsic/acquired resistance and limited treatment options.
Methods
A retrospective, observational cohort study in patients receiving cefiderocol via Shionogi's early access program for Acinetobacter spp infections (1 April 2020–30 April 2021; 27 sites; Italy, Spain, Germany, France). Primary outcome was clinical success, defined as clinical resolution of infection at day 14 or day 28 survival.
Results
Overall, 147 patients were included. Primary infection sites were respiratory (65.3%) and bloodstream (unknown source [15.6%]; catheter-related [10.9%]); 24.5% of patients had polymicrobial infection. Of 136 patients in intensive care (92.5%), 85.3% (116/136) received mechanical ventilation. Septic shock (55.6% [70/126]) and coronavirus disease 2019 (COVID-19) (81.6%) were prevalent. Prior to cefiderocol, 85.0% of patients received gram-negative treatment, 61.2% received ≥2 antimicrobials, and most received colistin (58.5%; median duration, 11.5 days). Cefiderocol monotherapy was used in 30.6% of patients. Clinical success rate was 53.1% and was higher in patients without septic shock (62.5%), without COVID-19 (77.8%), and with lower Sequential Organ Failure Assessment (SOFA) scores (quartile 1 [median, 3; range, 0–5]: 82.9%). Day 28 survival was 44.9% and was higher in patients without septic shock (60.7%), without COVID-19 (59.3%), with lower SOFA score (quartile 1: 82.9%), and receiving first-line cefiderocol (68.2% [15/22]). Resolution of infection at day 14 occurred in 39.5% of patients.
Conclusions
Despite use in complex patients with limited treatment options and high septic shock/COVID-19 rates, cefiderocol treatment was associated with an overall clinical success rate of 53%.
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Oncology
Reference43 articles.
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