Abstract：
BACKGROUND: No clear evidence supports the use of cefiderocol as first line treatment in A. baumannii infections.
METHODS: We conducted an observational retrospective/prospective multicenter study including all patients> 18 years with carbapenem-resistant A. baumannii (CRAB) infections treated with cefiderocol, from June 12021 to October 30 2022. Primary endpoint was 30-day mortality, secondary end-points the clinical and microbiological response at 7 days and at the end of treatment. Furthermore, we compared the clinical and microbiological outcomes among patients who received cefiderocol in monotherapy or in combination.
RESULTS: Thirty-eight patients with forty episodes of infection were included [mean age 65 years (SD+16.3), 75% males, 90% with hospital-acquired infections and 70% showing sepsis or septic shock]. The most common infections included unknown source or catheter-related bacteremia (45%) and pneumonia (40%). We observed at 7 days and at the end of therapy a rate of microbiological failure of 20% and 10%, respectively, and of clinical failure of 47.5% and 32.5%, respectively; the 30-day mortality rate was 47.5%. At multivariate analysis clinical failure at 7 days of treatment was the only independent predictor of 30-day mortality. Comparing monotherapy (used in 72.5%) vs. combination therapy (used in 27.5%), no differences were observed in mortality (51.7 vs 45.5%) and clinical (41.4 vs 63.7%) or microbiological failure (24.1 vs 9.1%).
CONCLUSIONS: The findings of this study reinforce the effectiveness of cefiderocol in CRAB infections, also as monotherapy. However, prospective multicenter studies with larger sample sizes and a control group treated with standard of care are needed to identify the best treatment for CRAB infections.
METHODS: We conducted an observational retrospective/prospective multicenter study including all patients> 18 years with carbapenem-resistant A. baumannii (CRAB) infections treated with cefiderocol, from June 12021 to October 30 2022. Primary endpoint was 30-day mortality, secondary end-points the clinical and microbiological response at 7 days and at the end of treatment. Furthermore, we compared the clinical and microbiological outcomes among patients who received cefiderocol in monotherapy or in combination.
RESULTS: Thirty-eight patients with forty episodes of infection were included [mean age 65 years (SD+16.3), 75% males, 90% with hospital-acquired infections and 70% showing sepsis or septic shock]. The most common infections included unknown source or catheter-related bacteremia (45%) and pneumonia (40%). We observed at 7 days and at the end of therapy a rate of microbiological failure of 20% and 10%, respectively, and of clinical failure of 47.5% and 32.5%, respectively; the 30-day mortality rate was 47.5%. At multivariate analysis clinical failure at 7 days of treatment was the only independent predictor of 30-day mortality. Comparing monotherapy (used in 72.5%) vs. combination therapy (used in 27.5%), no differences were observed in mortality (51.7 vs 45.5%) and clinical (41.4 vs 63.7%) or microbiological failure (24.1 vs 9.1%).
CONCLUSIONS: The findings of this study reinforce the effectiveness of cefiderocol in CRAB infections, also as monotherapy. However, prospective multicenter studies with larger sample sizes and a control group treated with standard of care are needed to identify the best treatment for CRAB infections.
摘要：
背景：没有明确的证据支持头孢地洛作为鲍曼不动杆菌感染的一线治疗。
方法：我们进行了一项观察性回顾性/前瞻性多中心研究，包括所有18岁以上的耐碳青霉烯鲍曼不动杆菌（CRAB）感染的患者，从12021年6月到2022年10月30日。主要终点是30天死亡率，次要终点是治疗第7天和治疗结束时的临床和微生物学反应.此外，我们比较了接受头孢地洛单药治疗或联合治疗的患者的临床和微生物学结局.
结果：纳入了38例感染发作的患者[平均年龄65岁（SD16.3），75%的男性,90％发生医院获得性感染，70％表现为败血症或败血症性休克]。最常见的感染包括不明来源或导管相关性菌血症（45％）和肺炎（40％）。我们观察到7天和治疗结束时微生物失败率为20％和10％，分别,临床失败的47.5%和32.5%，30天死亡率分别为47.5%。在多变量分析中，治疗7天的临床失败是30天死亡率的唯一独立预测因素。比较单一疗法（用于72.5%）与联合治疗（占27.5％），在死亡率(51.7vs45.5%)和临床(41.4vs63.7%)或微生物失效(24.1vs9.1%)方面没有观察到差异.
结论：这项研究的结果加强了头孢地洛在CRAB感染中的有效性，也作为单一疗法。然而,需要使用更大样本量的前瞻性多中心研究和接受标准治疗的对照组来确定CRAB感染的最佳治疗方法.
方法：我们进行了一项观察性回顾性/前瞻性多中心研究，包括所有18岁以上的耐碳青霉烯鲍曼不动杆菌（CRAB）感染的患者，从12021年6月到2022年10月30日。主要终点是30天死亡率，次要终点是治疗第7天和治疗结束时的临床和微生物学反应.此外，我们比较了接受头孢地洛单药治疗或联合治疗的患者的临床和微生物学结局.
结果：纳入了38例感染发作的患者[平均年龄65岁（SD16.3），75%的男性,90％发生医院获得性感染，70％表现为败血症或败血症性休克]。最常见的感染包括不明来源或导管相关性菌血症（45％）和肺炎（40％）。我们观察到7天和治疗结束时微生物失败率为20％和10％，分别,临床失败的47.5%和32.5%，30天死亡率分别为47.5%。在多变量分析中，治疗7天的临床失败是30天死亡率的唯一独立预测因素。比较单一疗法（用于72.5%）与联合治疗（占27.5％），在死亡率(51.7vs45.5%)和临床(41.4vs63.7%)或微生物失效(24.1vs9.1%)方面没有观察到差异.
结论：这项研究的结果加强了头孢地洛在CRAB感染中的有效性，也作为单一疗法。然而,需要使用更大样本量的前瞻性多中心研究和接受标准治疗的对照组来确定CRAB感染的最佳治疗方法.
