Background The role of cefiderocol (FDC) in the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) infections is still debated. Limited data are available on its real-world use in monotherapy versus combination therapy and on which partner drug is the most effective. Aims of the study: -to evaluate the clinical effectiveness of FDC used in monotherapy versus combination therapy for the treatment of CRAB infections; -to compare the main drug combination regimens used: FDC plus ampicillin/sulbactam (AMP/SUL) versus FDC plus fosfomycin (FOF). Methods Single centre retrospective-prospective study, enrolling patients with CRAB infection admitted to intensive care unit (ICU) and non-ICU wards from January 2021- December 2023. All included patients received FDC. Patients underwent to other drug regimens were excluded. Results Eighty-four (84) patients were included. 71 (84%) patients received FDC in combination, 13 (15%) as monotherapy. Bloodstream infections (BSI) (44;52%) and pneumonias (hospital acquired pneumonia-HAP/ventilator associated pneumonia-VAP) (37;44%) were the most frequent infections. No significant differences were observed in terms of clinical improvement, clinical cure, length of stay and 28-day mortality, between patients treated with monotherapy and those treated with combination therapy.[Table 1] No differences in major outcomes were reported in patients who received different drug regimens (monotherapy vs combination therapy) when analyzed by infection type (BSI vs HAP/VAP), except for a higher 30-day recurrence rate in patients with BSI treated with combination therapy ( p 0.0117).[Figure 1] Among combination regimens, the most frequently used were FDC+AMP/SUL (28) and FDC+FOF (20). No differences in outcomes were observed between these two drug regimens. [Table 2;Figure 2] The emergence of resistance was reported in only two patients (2.3%). In both cases, a combination regimens had been administered. Conclusions In real-world setting, FDC had shown similar effectiveness in both monotherapy and combination therapy, regardless of the infection type. No differences in outcomes were observed between patients treated with FDC +AMP/SUL and those treated with FDC+FOF.
Real-life use of cefiderocol in the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) infections: comparison between cefiderocol regimens and monotherapy / Covino, S., Lobello, S., Cogliati Dezza, F., Liguori, L., Petrucci, F., Cancelli, F., Comi, M., Figliomeni, S., Leanza, C., Sacco, F., Viscido, A., Alessandri, F., Ceccarelli, G., Raponi, G., Mastroianni, C.M., Oliva, A.. - (2026). (ESCMID Global 2026 Munich, Germany ).
Real-life use of cefiderocol in the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) infections: comparison between cefiderocol regimens and monotherapy
S. Covino;S. Lobello;F. Cogliati Dezza;L. Liguori;F. Petrucci;F. Cancelli;M. Comi;S. Figliomeni;C. Leanza;F. Sacco;A. Viscido;F. Alessandri;G. Ceccarelli;G. Raponi;C. M. Mastroianni;A. Oliva
2026
Abstract
Background The role of cefiderocol (FDC) in the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) infections is still debated. Limited data are available on its real-world use in monotherapy versus combination therapy and on which partner drug is the most effective. Aims of the study: -to evaluate the clinical effectiveness of FDC used in monotherapy versus combination therapy for the treatment of CRAB infections; -to compare the main drug combination regimens used: FDC plus ampicillin/sulbactam (AMP/SUL) versus FDC plus fosfomycin (FOF). Methods Single centre retrospective-prospective study, enrolling patients with CRAB infection admitted to intensive care unit (ICU) and non-ICU wards from January 2021- December 2023. All included patients received FDC. Patients underwent to other drug regimens were excluded. Results Eighty-four (84) patients were included. 71 (84%) patients received FDC in combination, 13 (15%) as monotherapy. Bloodstream infections (BSI) (44;52%) and pneumonias (hospital acquired pneumonia-HAP/ventilator associated pneumonia-VAP) (37;44%) were the most frequent infections. No significant differences were observed in terms of clinical improvement, clinical cure, length of stay and 28-day mortality, between patients treated with monotherapy and those treated with combination therapy.[Table 1] No differences in major outcomes were reported in patients who received different drug regimens (monotherapy vs combination therapy) when analyzed by infection type (BSI vs HAP/VAP), except for a higher 30-day recurrence rate in patients with BSI treated with combination therapy ( p 0.0117).[Figure 1] Among combination regimens, the most frequently used were FDC+AMP/SUL (28) and FDC+FOF (20). No differences in outcomes were observed between these two drug regimens. [Table 2;Figure 2] The emergence of resistance was reported in only two patients (2.3%). In both cases, a combination regimens had been administered. Conclusions In real-world setting, FDC had shown similar effectiveness in both monotherapy and combination therapy, regardless of the infection type. No differences in outcomes were observed between patients treated with FDC +AMP/SUL and those treated with FDC+FOF.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
