Cefiderocol Versus Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii Complex Bloodstream Infections: A Retrospective, Propensity-Score Adjusted, Monocentric Cohort Study
Abstract Introduction Bloodstream infections (BSI) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) are associated with high mortality with limited treatment. The aim of this study is to compare effectiveness and safety of colistin-based versus cefiderocol-based therapies for CRAB-BSI....
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Adis, Springer Healthcare
2023-09-01
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| Series: | Infectious Diseases and Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s40121-023-00854-6 |
| _version_ | 1797682629059805184 |
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| author | Davide Fiore Bavaro Roberta Papagni Alessandra Belati Lucia Diella Antonio De Luca Gaetano Brindicci Nicolò De Gennaro Francesco Di Gennaro Federica Romanelli Stefania Stolfa Luigi Ronga Adriana Mosca Francesco Pomarico Maria Dell’Aera Monica Stufano Lidia Dalfino Salvatore Grasso Annalisa Saracino |
| author_facet | Davide Fiore Bavaro Roberta Papagni Alessandra Belati Lucia Diella Antonio De Luca Gaetano Brindicci Nicolò De Gennaro Francesco Di Gennaro Federica Romanelli Stefania Stolfa Luigi Ronga Adriana Mosca Francesco Pomarico Maria Dell’Aera Monica Stufano Lidia Dalfino Salvatore Grasso Annalisa Saracino |
| author_sort | Davide Fiore Bavaro |
| collection | DOAJ |
| description | Abstract Introduction Bloodstream infections (BSI) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) are associated with high mortality with limited treatment. The aim of this study is to compare effectiveness and safety of colistin-based versus cefiderocol-based therapies for CRAB-BSI. Methods This is a retrospective observational study enrolling patients with monomicrobial CRAB-BSIs treated with colistin or cefiderocol from 1 January 2020, to 31 December 2022. The 30-day all-cause mortality rate was the primary outcome. A Cox regression analysis was performed to identify factors independently associated with mortality. A propensity score analysis using inverse probability of treatment weighting (IPTW) was also performed. Results Overall 118 patients were enrolled, 75 (63%) and 43 (37%) treated with colistin- and cefiderocol-based regimens. The median (q1–q3) age was 70 (62–79) years; 70 (59%) patients were men. The 30-day all-cause mortality was 52%, significantly lower in the cefiderocol group (40% vs 59%, p = 0.045). By performing a Cox regression model, age (aHR = 1.03, 95% CI 1.00–1.05), septic shock (aHR = 1.93, 95% CI 1.05–3.53), and delayed targeted therapy (aHR = 2.42, 95% CI 1.11–5.25) were independent predictors of mortality, while cefiderocol-based therapy was protective (aHR = 0.49, 95% CI 0.25–0.93). The IPTW-adjusted Cox analysis confirmed the protective effect of cefiderocol (aHR = 0.53, 95% CI 0.27–0.98). Conclusions Cefiderocol may be a valuable treatment option for CRAB-BSI, especially in the current context of limited treatment options. |
| first_indexed | 2024-03-12T00:02:37Z |
| format | Article |
| id | doaj.art-da853c7202ae4be99a3d50e99caf501a |
| institution | Directory Open Access Journal |
| issn | 2193-8229 2193-6382 |
| language | English |
| last_indexed | 2024-03-12T00:02:37Z |
| publishDate | 2023-09-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Infectious Diseases and Therapy |
| spelling | doaj.art-da853c7202ae4be99a3d50e99caf501a2023-09-17T11:22:24ZengAdis, Springer HealthcareInfectious Diseases and Therapy2193-82292193-63822023-09-011282147216310.1007/s40121-023-00854-6Cefiderocol Versus Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii Complex Bloodstream Infections: A Retrospective, Propensity-Score Adjusted, Monocentric Cohort StudyDavide Fiore Bavaro0Roberta Papagni1Alessandra Belati2Lucia Diella3Antonio De Luca4Gaetano Brindicci5Nicolò De Gennaro6Francesco Di Gennaro7Federica Romanelli8Stefania Stolfa9Luigi Ronga10Adriana Mosca11Francesco Pomarico12Maria Dell’Aera13Monica Stufano14Lidia Dalfino15Salvatore Grasso16Annalisa Saracino17Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of BariClinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of BariClinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of BariClinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of BariClinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of BariClinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of BariClinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of BariClinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of BariSection of Microbiology and Virology, Polyclinic of Bari, University of BariSection of Microbiology and Virology, Polyclinic of Bari, University of BariSection of Microbiology and Virology, Polyclinic of Bari, University of BariSection of Microbiology and Virology, Polyclinic of Bari, University of BariHospital Pharmacy Department, Polyclinic of Bari, University of BariHospital Pharmacy Department, Polyclinic of Bari, University of BariAnesthesia and Intensive Care Unit, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University of BariAnesthesia and Intensive Care Unit, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University of BariAnesthesia and Intensive Care Unit, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University of BariClinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of BariAbstract Introduction Bloodstream infections (BSI) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) are associated with high mortality with limited treatment. The aim of this study is to compare effectiveness and safety of colistin-based versus cefiderocol-based therapies for CRAB-BSI. Methods This is a retrospective observational study enrolling patients with monomicrobial CRAB-BSIs treated with colistin or cefiderocol from 1 January 2020, to 31 December 2022. The 30-day all-cause mortality rate was the primary outcome. A Cox regression analysis was performed to identify factors independently associated with mortality. A propensity score analysis using inverse probability of treatment weighting (IPTW) was also performed. Results Overall 118 patients were enrolled, 75 (63%) and 43 (37%) treated with colistin- and cefiderocol-based regimens. The median (q1–q3) age was 70 (62–79) years; 70 (59%) patients were men. The 30-day all-cause mortality was 52%, significantly lower in the cefiderocol group (40% vs 59%, p = 0.045). By performing a Cox regression model, age (aHR = 1.03, 95% CI 1.00–1.05), septic shock (aHR = 1.93, 95% CI 1.05–3.53), and delayed targeted therapy (aHR = 2.42, 95% CI 1.11–5.25) were independent predictors of mortality, while cefiderocol-based therapy was protective (aHR = 0.49, 95% CI 0.25–0.93). The IPTW-adjusted Cox analysis confirmed the protective effect of cefiderocol (aHR = 0.53, 95% CI 0.27–0.98). Conclusions Cefiderocol may be a valuable treatment option for CRAB-BSI, especially in the current context of limited treatment options.https://doi.org/10.1007/s40121-023-00854-6Antimicrobial resistanceBloodstream infectionsCarbapenem-resistant Acinetobacter baumanniiCefiderocolColistin |
| spellingShingle | Davide Fiore Bavaro Roberta Papagni Alessandra Belati Lucia Diella Antonio De Luca Gaetano Brindicci Nicolò De Gennaro Francesco Di Gennaro Federica Romanelli Stefania Stolfa Luigi Ronga Adriana Mosca Francesco Pomarico Maria Dell’Aera Monica Stufano Lidia Dalfino Salvatore Grasso Annalisa Saracino Cefiderocol Versus Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii Complex Bloodstream Infections: A Retrospective, Propensity-Score Adjusted, Monocentric Cohort Study Infectious Diseases and Therapy Antimicrobial resistance Bloodstream infections Carbapenem-resistant Acinetobacter baumannii Cefiderocol Colistin |
| title | Cefiderocol Versus Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii Complex Bloodstream Infections: A Retrospective, Propensity-Score Adjusted, Monocentric Cohort Study |
| title_full | Cefiderocol Versus Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii Complex Bloodstream Infections: A Retrospective, Propensity-Score Adjusted, Monocentric Cohort Study |
| title_fullStr | Cefiderocol Versus Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii Complex Bloodstream Infections: A Retrospective, Propensity-Score Adjusted, Monocentric Cohort Study |
| title_full_unstemmed | Cefiderocol Versus Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii Complex Bloodstream Infections: A Retrospective, Propensity-Score Adjusted, Monocentric Cohort Study |
| title_short | Cefiderocol Versus Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii Complex Bloodstream Infections: A Retrospective, Propensity-Score Adjusted, Monocentric Cohort Study |
| title_sort | cefiderocol versus colistin for the treatment of carbapenem resistant acinetobacter baumannii complex bloodstream infections a retrospective propensity score adjusted monocentric cohort study |
| topic | Antimicrobial resistance Bloodstream infections Carbapenem-resistant Acinetobacter baumannii Cefiderocol Colistin |
| url | https://doi.org/10.1007/s40121-023-00854-6 |
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