Empiric treatment of patients with sepsis and septic shock and place in therapy of cefiderocol: a systematic review and expert opinion statement
Abstract Carbapenem-resistant Gram-negative bacteria are frequent causes of sepsis and septic shock in intensive care unit (ICU) and thus considered a public health threat. Until now, the best available therapies consist of combinations of preexisting or new antibiotics with β-lactamase inhibitors (...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s44158-022-00062-7 |
| _version_ | 1811249902197407744 |
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| author | Andrea Cortegiani Giulia Ingoglia Mariachiara Ippolito Massimo Girardis Marco Falcone Federico Pea Francesco Pugliese Stefania Stefani Pierluigi Viale Antonino Giarratano |
| author_facet | Andrea Cortegiani Giulia Ingoglia Mariachiara Ippolito Massimo Girardis Marco Falcone Federico Pea Francesco Pugliese Stefania Stefani Pierluigi Viale Antonino Giarratano |
| author_sort | Andrea Cortegiani |
| collection | DOAJ |
| description | Abstract Carbapenem-resistant Gram-negative bacteria are frequent causes of sepsis and septic shock in intensive care unit (ICU) and thus considered a public health threat. Until now, the best available therapies consist of combinations of preexisting or new antibiotics with β-lactamase inhibitors (either new or preexisting). Several mechanisms of resistance, especially those mediated by metallo-β-lactamases (MBL), are responsible for the inefficacy of these treatments, leaving an unmet medical need. Intravenous cefiderocol has been recently approved by the American Food and Drug Administration (FDA) and European Medicines Agency (EMA) for the treatment of complicated urinary tract infections and nosocomial pneumonia due to Gram-negative, when limited therapeutical options are available. In addition, its ability to hijack bacterial iron uptake mechanisms makes cefiderocol stable against the whole Ambler β-lactamase inhibitors and increases the in vitro efficacy against Gram-negative pathogens (e.g., Enterobacterales spp., Pseudomonas aeruginosa, and Acinetobacter baumannii). Trials have already demonstrated their non-inferiority to comparators. In 2021, ESCMID guidelines released a conditional recommendation supporting the use of cefiderocol against metallo-β-lactamase-producing Enterobacterales and against Acinetobacter baumannii. This review provides the opinion of experts about the general management of empiric treatment of patients with sepsis and septic shock in the intensive care unit and detects the proper place in therapy of cefiderocol considering recent evidence sought through a systematic search. |
| first_indexed | 2024-04-12T15:55:40Z |
| format | Article |
| id | doaj.art-00b154afca3246fa9a7bcaf97517adb4 |
| institution | Directory Open Access Journal |
| issn | 2731-3786 |
| language | English |
| last_indexed | 2024-04-12T15:55:40Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj.art-00b154afca3246fa9a7bcaf97517adb42022-12-22T03:26:22ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862022-07-012111310.1186/s44158-022-00062-7Empiric treatment of patients with sepsis and septic shock and place in therapy of cefiderocol: a systematic review and expert opinion statementAndrea Cortegiani0Giulia Ingoglia1Mariachiara Ippolito2Massimo Girardis3Marco Falcone4Federico Pea5Francesco Pugliese6Stefania Stefani7Pierluigi Viale8Antonino Giarratano9Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of PalermoDepartment of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of PalermoDepartment of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of PalermoDepartment of Anesthesia and Intensive Care, University Hospital of ModenaDepartment of Clinical and Experimental Medicine, Infectious Diseases Unit, University of PisaDepartment of Medical and Surgical Sciences, Alma Mater Studiorum-University of BolognaDepartment of Anaesthesiology Critical Care Medicine and Pain Therapy, Policlinico Umberto I, Sapienza UniversityUniversity of Catania, Department of Biomedical and Biotechnological Sciences, Biological Tower, Third floor -Est TowerInfectious Diseases Unit, Department of Medical and Surgical Sciences, Sant’Orsola Hospital, University of BolognaDepartment of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of PalermoAbstract Carbapenem-resistant Gram-negative bacteria are frequent causes of sepsis and septic shock in intensive care unit (ICU) and thus considered a public health threat. Until now, the best available therapies consist of combinations of preexisting or new antibiotics with β-lactamase inhibitors (either new or preexisting). Several mechanisms of resistance, especially those mediated by metallo-β-lactamases (MBL), are responsible for the inefficacy of these treatments, leaving an unmet medical need. Intravenous cefiderocol has been recently approved by the American Food and Drug Administration (FDA) and European Medicines Agency (EMA) for the treatment of complicated urinary tract infections and nosocomial pneumonia due to Gram-negative, when limited therapeutical options are available. In addition, its ability to hijack bacterial iron uptake mechanisms makes cefiderocol stable against the whole Ambler β-lactamase inhibitors and increases the in vitro efficacy against Gram-negative pathogens (e.g., Enterobacterales spp., Pseudomonas aeruginosa, and Acinetobacter baumannii). Trials have already demonstrated their non-inferiority to comparators. In 2021, ESCMID guidelines released a conditional recommendation supporting the use of cefiderocol against metallo-β-lactamase-producing Enterobacterales and against Acinetobacter baumannii. This review provides the opinion of experts about the general management of empiric treatment of patients with sepsis and septic shock in the intensive care unit and detects the proper place in therapy of cefiderocol considering recent evidence sought through a systematic search.https://doi.org/10.1186/s44158-022-00062-7CefiderocolCarbapenem resistanceMultidrug resistanceGram-negative bacteriaUrinary tract infectionNosocomial pneumonia |
| spellingShingle | Andrea Cortegiani Giulia Ingoglia Mariachiara Ippolito Massimo Girardis Marco Falcone Federico Pea Francesco Pugliese Stefania Stefani Pierluigi Viale Antonino Giarratano Empiric treatment of patients with sepsis and septic shock and place in therapy of cefiderocol: a systematic review and expert opinion statement Journal of Anesthesia, Analgesia and Critical Care Cefiderocol Carbapenem resistance Multidrug resistance Gram-negative bacteria Urinary tract infection Nosocomial pneumonia |
| title | Empiric treatment of patients with sepsis and septic shock and place in therapy of cefiderocol: a systematic review and expert opinion statement |
| title_full | Empiric treatment of patients with sepsis and septic shock and place in therapy of cefiderocol: a systematic review and expert opinion statement |
| title_fullStr | Empiric treatment of patients with sepsis and septic shock and place in therapy of cefiderocol: a systematic review and expert opinion statement |
| title_full_unstemmed | Empiric treatment of patients with sepsis and septic shock and place in therapy of cefiderocol: a systematic review and expert opinion statement |
| title_short | Empiric treatment of patients with sepsis and septic shock and place in therapy of cefiderocol: a systematic review and expert opinion statement |
| title_sort | empiric treatment of patients with sepsis and septic shock and place in therapy of cefiderocol a systematic review and expert opinion statement |
| topic | Cefiderocol Carbapenem resistance Multidrug resistance Gram-negative bacteria Urinary tract infection Nosocomial pneumonia |
| url | https://doi.org/10.1186/s44158-022-00062-7 |
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