Cefiderocol Treatment for Severe Infections due to Difficult-to-Treat-Resistant Non-Fermentative Gram-Negative Bacilli in ICU Patients: A Case Series and Narrative Literature Review.

ICU 患者中难以治疗的非发酵革兰阴性杆菌引起的严重感染的头孢地洛治疗 ： 病例系列和叙事文献综述。

• 影响指数: 5.222
• 发表时间: 2023 Jun 1
• 来源期刊: Antibiotics (Basel)
• DOI: 10.3390/antibiotics12060991
• PMID: 37370310
• 文章类型: Journal Article
• 作者列表: Wicky PH,Poiraud J,Alves M,Patrier J,d'Humières C,Lê M,Kramer L,de Montmollin É,Massias L,Armand-Lefèvre L,Timsit JF

关键词: Acinetobacter baumannii; ECMO; Pseudomonas aeruginosa; Stenotrophomonas maltophilia; cefiderocol; critically ill; difficult-to-treat organisms

Abstract

Cefiderocol (FDC) is a siderophore cephalosporin now recognized as a new weapon in the treatment of difficult-to-treat-resistant (DTR) Gram-negative pathogens, including carbapenemase-producing enterobacterales and non-fermentative Gram-negative bacilli (GNB). This article reports our experience with an FDC-based regimen in the treatment of 16 extremely severe patients (invasive mechanical ventilation, 15/16; extracorporeal membrane oxygenation, 9/16; and renal replacement therapy, 8/16) infected with DTR GNB. Our case series provides detailed insight into the pharmacokinetic profile and the microbiological data in real-life conditions. In the narrative review, we discuss the interest of FDC in the treatment of non-fermentative GNB in critically ill patients. We reviewed the microbiological spectrum, resistance mechanisms, pharmacokinetics/pharmacodynamics, efficacy and safety profiles, and real-world evidence for FDC. On the basis of our experience and the available literature, we discuss the optimal FDC-based regimen, FDC dosage, and duration of therapy in critically ill patients with DTR non-fermentative GNB infections.

摘要

头孢地洛（FDC）是一种铁载体头孢菌素，现在被认为是治疗难以治疗的耐药（DTR）革兰氏阴性病原体的新武器，包括产生碳青霉烯酶的肠杆菌和非发酵革兰氏阴性杆菌（GNB）。本文报告了我们使用基于FDC的方案治疗16例极重度患者的经验（有创机械通气，15/16；体外膜氧合，9/16；和肾脏替代疗法，8/16)沾染了DTR一GNB。我们的案例系列提供了对现实生活中的药代动力学特征和微生物学数据的详细了解。在叙事审查中，我们讨论了FDC对危重病患者非发酵GNB治疗的兴趣.我们回顾了微生物光谱，抵抗机制，药代动力学/药效学，功效和安全性，和FDC的真实世界证据。根据我们的经验和现有文献，我们讨论了基于FDC的最佳方案，FDC剂量,DTR非发酵型GNB感染的危重患者的治疗时间。