Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidence
Abstract Appropriate antibiotic treatment for critically ill patients with serious Gram-negative infections in the intensive care unit is crucial to minimize morbidity and mortality. Several new antibiotics have shown in vitro activity against carbapenem-resistant Enterobacterales (CRE) and difficul...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-06-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-023-01146-5 |
| _version_ | 1797801266591563776 |
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| author | Pierluigi Viale Christian E. Sandrock Paula Ramirez Gian Maria Rossolini Thomas P. Lodise |
| author_facet | Pierluigi Viale Christian E. Sandrock Paula Ramirez Gian Maria Rossolini Thomas P. Lodise |
| author_sort | Pierluigi Viale |
| collection | DOAJ |
| description | Abstract Appropriate antibiotic treatment for critically ill patients with serious Gram-negative infections in the intensive care unit is crucial to minimize morbidity and mortality. Several new antibiotics have shown in vitro activity against carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat resistant Pseudomonas aeruginosa. Cefiderocol is the first approved siderophore beta-lactam antibiotic with potent activity against multidrug-resistant, carbapenem-resistant, difficult-to-treat or extensively drug-resistant Gram-negative pathogens, which have limited treatment options. The spectrum of activity of cefiderocol includes drug-resistant strains of Acinetobacter baumannii, P. aeruginosa, Stenotrophomonas maltophilia, Achromobacter spp. and Burkholderia spp. and CRE that produce serine- and/or metallo-carbapenemases. Phase 1 studies established that cefiderocol achieves adequate concentration in the epithelial lining fluid in the lung and requires dosing adjustment for renal function, including patients with augmented renal clearance and continuous renal-replacement therapy (CRRT); no clinically significant drug–drug interactions are expected. The non-inferiority of cefiderocol versus high-dose, extended-infusion meropenem in all-cause mortality (ACM) rates at day 14 was demonstrated in the randomized, double-blind APEKS–NP Phase 3 clinical study in patients with nosocomial pneumonia caused by suspected or confirmed Gram-negative bacteria. Furthermore, the efficacy of cefiderocol was investigated in the randomized, open-label, pathogen-focused, descriptive CREDIBLE–CR Phase 3 clinical study in its target patient population with serious carbapenem-resistant Gram-negative infections, including hospitalized patients with nosocomial pneumonia, bloodstream infection/sepsis, or complicated urinary tract infections. However, a numerically greater ACM rate with cefiderocol compared with BAT led to the inclusion of a warning in US and European prescribing information. Cefiderocol susceptibility results obtained with commercial tests should be carefully evaluated due to current issues regarding their accuracy and reliability. Since its approval, real-world evidence in patients with multidrug-resistant and carbapenem-resistant Gram-negative bacterial infections suggests that cefiderocol can be efficacious in certain critically ill patient groups, such as those requiring mechanical ventilation for COVID-19 pneumonia with subsequently acquired Gram-negative bacterial superinfection, and patients with CRRT and/or extracorporeal membrane oxygenation. In this article, we review the microbiological spectrum, pharmacokinetics/pharmacodynamics, efficacy and safety profiles and real-world evidence for cefiderocol, and look at future considerations for its role in the treatment of critically ill patients with challenging Gram-negative bacterial infections. |
| first_indexed | 2024-03-13T04:47:51Z |
| format | Article |
| id | doaj.art-c8dc2d4958d040ebbabef66790fab6a4 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-03-13T04:47:51Z |
| publishDate | 2023-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-c8dc2d4958d040ebbabef66790fab6a42023-06-18T11:24:47ZengSpringerOpenAnnals of Intensive Care2110-58202023-06-0113112510.1186/s13613-023-01146-5Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidencePierluigi Viale0Christian E. Sandrock1Paula Ramirez2Gian Maria Rossolini3Thomas P. Lodise4Infectious Disease Unit, IRCCS Policlinico di Sant’OrsolaDivision of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of CaliforniaServicio de Medicina Intensiva, Hospital Universitario y Politécnico la FeDepartment of Experimental and Clinical Medicine, University of FlorenceDepartment of Pharmacy Practice, Albany College of Pharmacy and Health SciencesAbstract Appropriate antibiotic treatment for critically ill patients with serious Gram-negative infections in the intensive care unit is crucial to minimize morbidity and mortality. Several new antibiotics have shown in vitro activity against carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat resistant Pseudomonas aeruginosa. Cefiderocol is the first approved siderophore beta-lactam antibiotic with potent activity against multidrug-resistant, carbapenem-resistant, difficult-to-treat or extensively drug-resistant Gram-negative pathogens, which have limited treatment options. The spectrum of activity of cefiderocol includes drug-resistant strains of Acinetobacter baumannii, P. aeruginosa, Stenotrophomonas maltophilia, Achromobacter spp. and Burkholderia spp. and CRE that produce serine- and/or metallo-carbapenemases. Phase 1 studies established that cefiderocol achieves adequate concentration in the epithelial lining fluid in the lung and requires dosing adjustment for renal function, including patients with augmented renal clearance and continuous renal-replacement therapy (CRRT); no clinically significant drug–drug interactions are expected. The non-inferiority of cefiderocol versus high-dose, extended-infusion meropenem in all-cause mortality (ACM) rates at day 14 was demonstrated in the randomized, double-blind APEKS–NP Phase 3 clinical study in patients with nosocomial pneumonia caused by suspected or confirmed Gram-negative bacteria. Furthermore, the efficacy of cefiderocol was investigated in the randomized, open-label, pathogen-focused, descriptive CREDIBLE–CR Phase 3 clinical study in its target patient population with serious carbapenem-resistant Gram-negative infections, including hospitalized patients with nosocomial pneumonia, bloodstream infection/sepsis, or complicated urinary tract infections. However, a numerically greater ACM rate with cefiderocol compared with BAT led to the inclusion of a warning in US and European prescribing information. Cefiderocol susceptibility results obtained with commercial tests should be carefully evaluated due to current issues regarding their accuracy and reliability. Since its approval, real-world evidence in patients with multidrug-resistant and carbapenem-resistant Gram-negative bacterial infections suggests that cefiderocol can be efficacious in certain critically ill patient groups, such as those requiring mechanical ventilation for COVID-19 pneumonia with subsequently acquired Gram-negative bacterial superinfection, and patients with CRRT and/or extracorporeal membrane oxygenation. In this article, we review the microbiological spectrum, pharmacokinetics/pharmacodynamics, efficacy and safety profiles and real-world evidence for cefiderocol, and look at future considerations for its role in the treatment of critically ill patients with challenging Gram-negative bacterial infections.https://doi.org/10.1186/s13613-023-01146-5Appropriate antibioticCefiderocolCritically illDosingMultidrug-resistant Gram-negative bacteriaNosocomial pneumonia |
| spellingShingle | Pierluigi Viale Christian E. Sandrock Paula Ramirez Gian Maria Rossolini Thomas P. Lodise Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidence Annals of Intensive Care Appropriate antibiotic Cefiderocol Critically ill Dosing Multidrug-resistant Gram-negative bacteria Nosocomial pneumonia |
| title | Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidence |
| title_full | Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidence |
| title_fullStr | Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidence |
| title_full_unstemmed | Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidence |
| title_short | Treatment of critically ill patients with cefiderocol for infections caused by multidrug-resistant pathogens: review of the evidence |
| title_sort | treatment of critically ill patients with cefiderocol for infections caused by multidrug resistant pathogens review of the evidence |
| topic | Appropriate antibiotic Cefiderocol Critically ill Dosing Multidrug-resistant Gram-negative bacteria Nosocomial pneumonia |
| url | https://doi.org/10.1186/s13613-023-01146-5 |
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