Cerebrospinal fluid concentrations of cefiderocol during the treatment of extensively drug-resistant <i>Pseudomonas aeruginosa</i> ventriculitis
David Luque-Paz, Youssef Bennis, Paul Jaubert, Vincent Dubée, Michel Wolff, Satar Mortaza
Abstract
Ventriculitis is a severe complication of CSF drainage; staphylococci and Gram-negative bacilli (including Pseudomonas aeruginosa) being the two main categories of pathogens responsible for this infection.1,2 Ventriculitis is a difficult-to-treat infection associated with poor outcomes.3 Cefiderocol is a new injectable siderophore cephalosporin antibiotic with an extended Gram-negative activity spectrum including carbapenem-resistant bacteria. It was approved by the FDA for the treatment of complicated urinary tract infections and nosocomial pneumonia.4,5 To our best knowledge, no data regarding CSF concentrations of cefiderocol are available. Here, we describe cefiderocol pharmacokinetics in a patient suffering from XDR P. aeruginosa catheter-related ventriculitis who was treated with this new antibiotic. Plasma and CSF concentrations of cefiderocol were determined using a validated rapid HPLC method as previously described.6 Next of kin gave written informed consent for the publication of these data. In June 2021, a patient in their 70s weighing 78 kg underwent pituitary surgery for the removal of a craniopharyngioma. Because of acute hydrocephalus, an external ventricular drain (EVD) was inserted immediately after surgery. On Day 24, the patient developed meningitis due to P. aeruginosa and received a first-line regimen consisting of a 14 day course of meropenem (2 g every 8 h) combined with ciprofloxacin (750 mg every 12 h). Hydrocephalus persisted and the EVD was replaced by ventriculoperitoneal shunt. The per-surgery CSF culture yielded P. aeruginosa with the same antibiotic susceptibility profile, and the patient received a second course of meropenem and ciprofloxacin.