%0 Multicenter Study
%T Outcome of patients with carbapenem-resistant Acinetobacter baumannii infections treated with cefiderocol: A multicenter observational study.
%A Calò F
%A Onorato L
%A De Luca I
%A Macera M
%A Monari C
%A Durante-Mangoni E
%A Massa A
%A Gentile I
%A Di Caprio G
%A Pagliano P
%A Numis FG
%A Iuliano P
%A Buonomo AR
%A Leone S
%A Maggi P
%A Coppola N
%J J Infect Public Health
%V 16
%N 9
%D 2023 Sep 14
%M 37349243
%F 7.537
%R 10.1016/j.jiph.2023.06.009
%X <B>BACKGROUND: </B>No clear evidence supports the use of cefiderocol as first line treatment in A. baumannii infections.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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%).<BR><B>CONCLUSIONS: </B>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.