Abstract：
BACKGROUND: Cefiderocol is a siderophore cephalosporin showing activity against various carbapenem-resistant Gram-negative bacteria (CR-GNB). No data currently exist about real-world use of cefiderocol in terms of types of therapy (e.g., empirical or targeted, monotherapy or combined regimens), indications, and patient characteristics.
METHODS: In this multicenter, prospective study, we aimed at describing the use of cefiderocol in terms of types of therapy, indications, and patient characteristics.
RESULTS: Cefiderocol was administered as empirical and targeted therapy in 27.5% (55/200) and 72.5% (145/200) of cases, respectively. Overall, it was administered as monotherapy in 101/200 cases (50.5%) and as part of a combined regimen for CR-GNB infections in the remaining 99/200 cases (49.5%). In multivariable analysis, previous isolation of carbapenem-resistant Acinetobacter baumannii odds ratio (OR) 2.56, with 95% confidence interval (95% CI) 1.01-6.46, p = 0.047] and previous hematopoietic stem cell transplantation (OR 8.73, 95% CI 1.05-72.54, p = 0.045) were associated with administration of cefiderocol as part of a combined regimen, whereas chronic kidney disease was associated with cefiderocol monotherapy (OR 0.38 for combined regimen, 95% CI 0.16-0.91, p = 0.029). Cumulative 30-day mortality was 19.8%, 45.0%, 20.7%, and 22.7% in patients receiving targeted cefiderocol for infections by Enterobacterales, A. baumannii, Pseudomonas aeruginosa, and any metallo-β-lactamase producers, respectively.
CONCLUSIONS: Cefiderocol is mainly used for targeted treatment, although empirical therapies account for more than 25% of prescriptions, thus requiring dedicated standardization and guidance. The almost equal distribution of cefiderocol monotherapy and cefiderocol-based combination therapies underlines the need for further study to ascertain possible differences in efficacy between the two approaches.
METHODS: In this multicenter, prospective study, we aimed at describing the use of cefiderocol in terms of types of therapy, indications, and patient characteristics.
RESULTS: Cefiderocol was administered as empirical and targeted therapy in 27.5% (55/200) and 72.5% (145/200) of cases, respectively. Overall, it was administered as monotherapy in 101/200 cases (50.5%) and as part of a combined regimen for CR-GNB infections in the remaining 99/200 cases (49.5%). In multivariable analysis, previous isolation of carbapenem-resistant Acinetobacter baumannii odds ratio (OR) 2.56, with 95% confidence interval (95% CI) 1.01-6.46, p = 0.047] and previous hematopoietic stem cell transplantation (OR 8.73, 95% CI 1.05-72.54, p = 0.045) were associated with administration of cefiderocol as part of a combined regimen, whereas chronic kidney disease was associated with cefiderocol monotherapy (OR 0.38 for combined regimen, 95% CI 0.16-0.91, p = 0.029). Cumulative 30-day mortality was 19.8%, 45.0%, 20.7%, and 22.7% in patients receiving targeted cefiderocol for infections by Enterobacterales, A. baumannii, Pseudomonas aeruginosa, and any metallo-β-lactamase producers, respectively.
CONCLUSIONS: Cefiderocol is mainly used for targeted treatment, although empirical therapies account for more than 25% of prescriptions, thus requiring dedicated standardization and guidance. The almost equal distribution of cefiderocol monotherapy and cefiderocol-based combination therapies underlines the need for further study to ascertain possible differences in efficacy between the two approaches.
摘要：
背景：头孢地洛是一种铁载体头孢菌素，对各种耐碳青霉烯的革兰氏阴性菌（CR-GNB）具有活性。目前没有关于头孢地洛在治疗类型方面的实际使用的数据(例如，经验性的或有针对性的，单一疗法或联合方案)，适应症,和患者特征。
方法：在这个多中心中，前瞻性研究，我们旨在描述头孢地洛在治疗类型方面的使用，适应症,和患者特征。
结果：头孢地洛作为经验性和靶向性治疗在27.5％（55/200）和72.5％（145/200）的病例中使用，分别。总的来说,101/200例(50.5%)采用单药治疗,其余99/200例(49.5%)采用联合方案治疗CR-GNB感染.在多变量分析中，先前分离耐碳青霉烯的鲍曼不动杆菌比值比（OR）2.56，具有95％置信区间（95％CI）1.01-6.46，p=0.047]和先前的造血干细胞移植（OR8.73，95％CI1.05-72.54，p=0.045）与作为联合方案的一部分的头孢地洛的给药有关，而慢性肾脏病与头孢地洛单药治疗相关（联合治疗方案的OR为0.38，95%CI0.16-0.91，p=0.029）。累积30天死亡率为19.8%，45.0%,20.7%,接受靶向头孢地洛治疗肠杆菌感染的患者占22.7%，A.鲍曼尼,铜绿假单胞菌,和任何金属β-内酰胺酶生产者，分别。
结论：头孢地洛主要用于靶向治疗，尽管经验疗法占处方的25%以上，因此需要专门的标准化和指导。头孢地洛单药治疗和基于头孢地洛的联合治疗的几乎相等的分布强调了需要进一步研究以确定两种方法之间可能的疗效差异。
方法：在这个多中心中，前瞻性研究，我们旨在描述头孢地洛在治疗类型方面的使用，适应症,和患者特征。
结果：头孢地洛作为经验性和靶向性治疗在27.5％（55/200）和72.5％（145/200）的病例中使用，分别。总的来说,101/200例(50.5%)采用单药治疗,其余99/200例(49.5%)采用联合方案治疗CR-GNB感染.在多变量分析中，先前分离耐碳青霉烯的鲍曼不动杆菌比值比（OR）2.56，具有95％置信区间（95％CI）1.01-6.46，p=0.047]和先前的造血干细胞移植（OR8.73，95％CI1.05-72.54，p=0.045）与作为联合方案的一部分的头孢地洛的给药有关，而慢性肾脏病与头孢地洛单药治疗相关（联合治疗方案的OR为0.38，95%CI0.16-0.91，p=0.029）。累积30天死亡率为19.8%，45.0%,20.7%,接受靶向头孢地洛治疗肠杆菌感染的患者占22.7%，A.鲍曼尼,铜绿假单胞菌,和任何金属β-内酰胺酶生产者，分别。
结论：头孢地洛主要用于靶向治疗，尽管经验疗法占处方的25%以上，因此需要专门的标准化和指导。头孢地洛单药治疗和基于头孢地洛的联合治疗的几乎相等的分布强调了需要进一步研究以确定两种方法之间可能的疗效差异。
