Cefiderocol therapy among immunocompromised adult patients: a descriptive analysis from a prospective, multicentre cohort study

The global rise in infections due to multidrug-resistant Gram-negative bacteria (MDRGNB) infections has disproportionately impacted immunocompromised (IC) hosts. Cefiderocol, a novel siderophore cephalosporin, exhibits potent activity against MDRGNB, but limited data exist on its use in IC patients. This study aimed to describe cefiderocol use in IC patients. Patients and therapy characteristics were descriptively reported, and outcomes were compared between IC and non-IC patients. Cox regression models were used to identify factors associated with mortality. Among 185 patients, 84 (45.4%) were IC. Similar descriptive rates were observed in IC and non-IC groups regarding indications for cefiderocol use, choice of monotherapy versus combination therapy, or empirical versus targeted treatment. The 28-day clinical cure rates were similar across patients receiving targeted cefiderocol therapy for infection due to Pseudomonas aeruginosa (81%, 17/21), Enterobacterales (77.3%, 17/22) and Acinetobacter baumannii (42%, 21/50). Thirty-day mortality was comparable between IC and non-IC patients (40.8%, 95% confidence interval [CI] 27.9–56.8 vs 33.3%, 95% CI 22.9–46.9; p = 0.5430). In multivariable analysis IC status was not associated with higher mortality. Cefiderocol use in IC patients resulted in clinical outcomes comparable to non-IC patients when treating MDRGNB infections. IC status was not associated with an increased mortality, emphasising the importance of effective antimicrobial therapy. Further investigation is needed to clarify the relative impact of the administered treatment vs. the patients’ clinical condition in influencing the prognosis of Acinetobacter baumannii infections.

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Journal
BMC Infectious Diseases
Published
2025-10-16
DOI
https://doi.org/10.1186/s12879-025-11573-3
Primary Topic
Pneumocystis jirovecii pneumonia detection and treatment
Type
article
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article

Cefiderocol therapy among immunocompromised adult patients: a descriptive analysis from a prospective, multicentre cohort study

Federica Portunato, Chiara Fanelli, Antonio Di Biagio, Vincenzo Scaglione et al.
BMC Infectious Diseases
Pneumocystis jirovecii pneumonia detection and treatment
article

Cefiderocol therapy among immunocompromised adult patients: a descriptive analysis from a prospective, multicentre cohort study

Federica Portunato, Chiara Fanelli, Antonio Di Biagio, Vincenzo Scaglione, Marcello Feasi, Marco Berruti, Alessandro Russo, Giulia Viero, Maria Mazzitelli, Valerio Del Bono, Francesca Raffaelli, Nicoletta Boffa, Matteo Rinaldi, C Grillo, Michele Spinicci, Nicola Rosso, Sabrina Boraso, Chiara Oltolini, Chiara Aldieri, Francesca Serapide, Laura Labate, Giovanni Cenderello, Erika Coppo, Marco Ripa, Małgorzata Mikulska, Nicholas Geremia, Alessio Signori, Chiara Maci, Andrea Lombardi, Alessandra Calabresi, Aurora Bonazza, Anna Maria Cattelan, Federico Capra Marzani, Carlo Pallotto, Silvia Corcione, Antonino Giarratano, Marco Muccio, Paola Del Giacomo, Alice Cappello, Matteo Bassetti, Fiorenza Fava, Edoardo Campanella, Alessandra Mularoni, L. Ceccarelli, Daniela Francisci, Francesco Saverio Serino, Nour Shbaklo, Ivana Maida, Vincenzo Di Pilato, Mauro Giacomini, Elena Potenza, Sara Mora, Sandro Panese, Emanuele Pontali, Federico D’Amico, Anna Marchese, Kristian Scolz, Erika Asperges, Giovanna Travi, Maddalena Giannella, Lorenzo Ball, Paola Saltini, B Mariani, Teresa Fasciana, Angela Raffaella Losito, Donatella Concetta Cibelli, Sabrina Guastavino, Francesco Giuseppe De Rosa, Andrea Cortegiani, Mario Tumbarello, Cecilia Azzarà, Gabriele Di Meco, Alessandra Bandera, Daniele Roberto Giacobbe, Iole Brunetti, Cristina Campi, Antonio Vena, Antonio Muscatello, Gianmaria Baldin, Marco Merli, Filippo Del Puente, Roberta Monardo, Andrea Marıno, Maria Chiara Meloni, Davide Mangioni, Carlo Torti, Chiara Gullotta, Chiara Robba, Enrico Maria Trecarichi, Teresa Santantonio, Rosario Cultrera, Daniele Mengato, Cristina Marelli, Giulia Catalisano, Michele Piana, Federica Briano, Lucia Graziani, Denise Battaglini, Silvia Boni, Bruno Cacopardo, Giulia Viglietti, Elena Momesso, Gabriele Giuliano, Ylenia Murgia, Francesco Truffelli, Margherita Albagini, Alessandro Bartoloni, Monica Rizzo, Chiara Russo Artimagnella, Antonella Castagna, Pierluigi Viale, Margherita Sambo, C. Grosso, Anna Carretta, Ludovica Corsello, Francesco Fele, Benedetta Casciato, Elena Baranello
article en

Abstract

The global rise in infections due to multidrug-resistant Gram-negative bacteria (MDRGNB) infections has disproportionately impacted immunocompromised (IC) hosts. Cefiderocol, a novel siderophore cephalosporin, exhibits potent activity against MDRGNB, but limited data exist on its use in IC patients. This study aimed to describe cefiderocol use in IC patients. Patients and therapy characteristics were descriptively reported, and outcomes were compared between IC and non-IC patients. Cox regression models were used to identify factors associated with mortality. Among 185 patients, 84 (45.4%) were IC. Similar descriptive rates were observed in IC and non-IC groups regarding indications for cefiderocol use, choice of monotherapy versus combination therapy, or empirical versus targeted treatment. The 28-day clinical cure rates were similar across patients receiving targeted cefiderocol therapy for infection due to Pseudomonas aeruginosa (81%, 17/21), Enterobacterales (77.3%, 17/22) and Acinetobacter baumannii (42%, 21/50). Thirty-day mortality was comparable between IC and non-IC patients (40.8%, 95% confidence interval [CI] 27.9–56.8 vs 33.3%, 95% CI 22.9–46.9; p = 0.5430). In multivariable analysis IC status was not associated with higher mortality. Cefiderocol use in IC patients resulted in clinical outcomes comparable to non-IC patients when treating MDRGNB infections. IC status was not associated with an increased mortality, emphasising the importance of effective antimicrobial therapy. Further investigation is needed to clarify the relative impact of the administered treatment vs. the patients’ clinical condition in influencing the prognosis of Acinetobacter baumannii infections.

BMC Infectious DiseasesVol. 25(1)
University of Siena (IT), Università Cattolica del Sacro Cuore (IT), University of Foggia (IT), Tufts University (US), AOL (United States) (US), University of Padua (IT), Vita-Salute San Raffaele University (IT), University of Sassari (IT), University of Milan (IT), University of Ferrara (IT), University of Perugia (IT), Agostino Gemelli University Polyclinic (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Ente Ospedaliero Ospedali Galliera (IT), Magna Graecia University (IT), University of Catania (IT), Ospedale Maggiore (IT), Azienda Ospedaliera di Perugia (IT), Ospedale San Paolo (IT), Ospedale di Sanremo (IT), Dulbecco Telethon Institute (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT), Azienda Unità Sanitaria Locale di Ferrara (IT), Ospedale di San Donà di Piave (IT), Ospedale Garibaldi (IT), Ospedale San Paolo (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Ospedale Santa Maria (IT), Azienda Ospedaliera Universitaria Senese (IT), Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT), Ospedale dell' Angelo (IT), Ospedale Policlinico San Martino (IT), Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo (IT), Azienda Sanitaria Locale N. 2 Savonese (IT), Policlinico San Matteo Fondazione (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo (IT), Link Campus University (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), University of Florence (IT), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IT), University of Turin (IT), University of Palermo (IT), University of Bologna (IT)
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