Carbapenem-Resistant <i>Acinetobacter</i> spp Infection in Critically Ill Patients With Limited Treatment Options: A Descriptive Study of Cefiderocol Therapy During the COVID-19 Pandemic
Maddalena Giannella, Stefano Verardi, Andreas Karas, Hasania Abdel Hadi, Hervé Dupont, Àlex Soriano, Anne Santerre Henriksen, Andrew I. Cooper, Marco Falcone, ARES Study Group, Pierluigi Viale, Maddalena Giannella, Renato Pascale, Marco Falcone, Giusy Tiseo, Alessandra Bandera, Toussaint Muheberimana, Valeria Pastore, Alessandra Saracino, Davide Fiore Bavaro, Lidia Dalfino, Luca Guerra, Francesco Barchiesi, Ylenia Farinaccio, Chiara Temperoni, Giustino Parruti, Simona Coladonato, Giorgia Rapacchiale, Laurenzia Ferraris, Alessandro Meloni, Andrea Bruni, Eugenio Garofalo, Carlo Torti, Paolo Grossi, Emanuele Durante‐Mangoni, Alessia Massa, Fabiana D’Amico, Domenico Iossa, Arta Karruli, Novella Carannante, Marco Merli, Carlo Pallotto, Elena Seminari, Samantha Sottotetti, Roberto G. Carbone, Stefania Casolari, Elisa Vanino, Francesco Cristini, Luigi Raumer, Gennaro De Pascale, Agnese di Chiaro, L. Cubattoli, Alessandro Bartoloni, Nicoletta Di Lauria, Mario Venditti, Alessandra Oliva, Rosario Cultrera, Hasania Abdel Hadi, Carmen Hidalgo Tenorio, David Pérez-Torres, Isabel Canas-Pérez, Luis López-Urrutia Lorente, Montserrat Rodriguez, Bárbara Balandín, R. Lepeule, Dominic Wichmann, Christina König, Dominik Jarczak
Abstract
Background: infections are difficult to treat and are a significant public health threat due to intrinsic/acquired resistance and limited treatment options. Methods: spp infections (1 April 2020-30 April 2021; 27 sites; Italy, Spain, Germany, France). Primary outcome was clinical success, defined as clinical resolution of infection at day 14 or day 28 survival. Results: Overall, 147 patients were included. Primary infection sites were respiratory (65.3%) and bloodstream (unknown source [15.6%]; catheter-related [10.9%]); 24.5% of patients had polymicrobial infection. Of 136 patients in intensive care (92.5%), 85.3% (116/136) received mechanical ventilation. Septic shock (55.6% [70/126]) and coronavirus disease 2019 (COVID-19) (81.6%) were prevalent. Prior to cefiderocol, 85.0% of patients received gram-negative treatment, 61.2% received ≥2 antimicrobials, and most received colistin (58.5%; median duration, 11.5 days). Cefiderocol monotherapy was used in 30.6% of patients. Clinical success rate was 53.1% and was higher in patients without septic shock (62.5%), without COVID-19 (77.8%), and with lower Sequential Organ Failure Assessment (SOFA) scores (quartile 1 [median, 3; range, 0-5]: 82.9%). Day 28 survival was 44.9% and was higher in patients without septic shock (60.7%), without COVID-19 (59.3%), with lower SOFA score (quartile 1: 82.9%), and receiving first-line cefiderocol (68.2% [15/22]). Resolution of infection at day 14 occurred in 39.5% of patients. Conclusions: Despite use in complex patients with limited treatment options and high septic shock/COVID-19 rates, cefiderocol treatment was associated with an overall clinical success rate of 53%.