Compassionate use of cefiderocol for carbapenem-resistant Acinetobacter baumannii prosthetic joint infection
Abstract Background Cefiderocol is a recently licensed novel siderophore-conjugated cephalosporin stable to hydrolysis by serine and MBLs. It has been successfully used to treat Enterobacterales infections and is approved for the treatment of infections due to aerobic Gram-negative organisms in adul...
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Published in | JAC-antimicrobial resistance Vol. 3; no. Supplement_1; pp. i21 - i24 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
England
Oxford University Press
01.06.2021
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Abstract | Abstract
Background
Cefiderocol is a recently licensed novel siderophore-conjugated cephalosporin stable to hydrolysis by serine and MBLs. It has been successfully used to treat Enterobacterales infections and is approved for the treatment of infections due to aerobic Gram-negative organisms in adults with limited treatment options.
Objectives
To describe the compassionate use of cefiderocol and clinical outcome in a case of prosthetic joint infection due to MDR Acinetobacter baumannii.
Patients and methods
This case study follows a 66-year-old woman who sustained an open fracture of the left distal humerus in Pakistan. She underwent open reduction and internal fixation and on return to the UK presented to hospital with a discharging surgical wound.
Results
Debridement of her wound cultured NDM carbapenemase-producing A. baumannii susceptible to colistin, tobramycin and tigecycline only. She developed vomiting with acute kidney injury with colistin and tigecycline. Antimicrobial efficacy of cefiderocol was predicted from in vitro and in vivo susceptibility tests. A successful request was made to Shionogi for compassionate use of cefiderocol, which was added to tigecycline. Cefiderocol was well tolerated with no toxicity and improved renal function. In total she received 25 days of cefiderocol and continued on tigecycline for a further 6 weeks in the community. She has well-healed wounds and good range of elbow movement.
Conclusions
Cefiderocol’s novel mode of cell entry is effective against MDR Gram-negative bacteria with reduced toxicity compared with other last line antibiotics. Our case demonstrates that cefiderocol may be useful as therapy for patients with limited treatment options due to antimicrobial resistance. |
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AbstractList | Cefiderocol is a recently licensed novel siderophore-conjugated cephalosporin stable to hydrolysis by serine and MBLs. It has been successfully used to treat Enterobacterales infections and is approved for the treatment of infections due to aerobic Gram-negative organisms in adults with limited treatment options.
To describe the compassionate use of cefiderocol and clinical outcome in a case of prosthetic joint infection due to MDR
.
This case study follows a 66-year-old woman who sustained an open fracture of the left distal humerus in Pakistan. She underwent open reduction and internal fixation and on return to the UK presented to hospital with a discharging surgical wound.
Debridement of her wound cultured NDM carbapenemase-producing
susceptible to colistin, tobramycin and tigecycline only. She developed vomiting with acute kidney injury with colistin and tigecycline. Antimicrobial efficacy of cefiderocol was predicted from
and
susceptibility tests. A successful request was made to Shionogi for compassionate use of cefiderocol, which was added to tigecycline. Cefiderocol was well tolerated with no toxicity and improved renal function. In total she received 25 days of cefiderocol and continued on tigecycline for a further 6 weeks in the community. She has well-healed wounds and good range of elbow movement.
Cefiderocol's novel mode of cell entry is effective against MDR Gram-negative bacteria with reduced toxicity compared with other last line antibiotics. Our case demonstrates that cefiderocol may be useful as therapy for patients with limited treatment options due to antimicrobial resistance. BACKGROUNDCefiderocol is a recently licensed novel siderophore-conjugated cephalosporin stable to hydrolysis by serine and MBLs. It has been successfully used to treat Enterobacterales infections and is approved for the treatment of infections due to aerobic Gram-negative organisms in adults with limited treatment options. OBJECTIVESTo describe the compassionate use of cefiderocol and clinical outcome in a case of prosthetic joint infection due to MDR Acinetobacter baumannii. PATIENTS AND METHODSThis case study follows a 66-year-old woman who sustained an open fracture of the left distal humerus in Pakistan. She underwent open reduction and internal fixation and on return to the UK presented to hospital with a discharging surgical wound. RESULTSDebridement of her wound cultured NDM carbapenemase-producing A. baumannii susceptible to colistin, tobramycin and tigecycline only. She developed vomiting with acute kidney injury with colistin and tigecycline. Antimicrobial efficacy of cefiderocol was predicted from in vitro and in vivo susceptibility tests. A successful request was made to Shionogi for compassionate use of cefiderocol, which was added to tigecycline. Cefiderocol was well tolerated with no toxicity and improved renal function. In total she received 25 days of cefiderocol and continued on tigecycline for a further 6 weeks in the community. She has well-healed wounds and good range of elbow movement. CONCLUSIONSCefiderocol's novel mode of cell entry is effective against MDR Gram-negative bacteria with reduced toxicity compared with other last line antibiotics. Our case demonstrates that cefiderocol may be useful as therapy for patients with limited treatment options due to antimicrobial resistance. Abstract Background Cefiderocol is a recently licensed novel siderophore-conjugated cephalosporin stable to hydrolysis by serine and MBLs. It has been successfully used to treat Enterobacterales infections and is approved for the treatment of infections due to aerobic Gram-negative organisms in adults with limited treatment options. Objectives To describe the compassionate use of cefiderocol and clinical outcome in a case of prosthetic joint infection due to MDR Acinetobacter baumannii. Patients and methods This case study follows a 66-year-old woman who sustained an open fracture of the left distal humerus in Pakistan. She underwent open reduction and internal fixation and on return to the UK presented to hospital with a discharging surgical wound. Results Debridement of her wound cultured NDM carbapenemase-producing A. baumannii susceptible to colistin, tobramycin and tigecycline only. She developed vomiting with acute kidney injury with colistin and tigecycline. Antimicrobial efficacy of cefiderocol was predicted from in vitro and in vivo susceptibility tests. A successful request was made to Shionogi for compassionate use of cefiderocol, which was added to tigecycline. Cefiderocol was well tolerated with no toxicity and improved renal function. In total she received 25 days of cefiderocol and continued on tigecycline for a further 6 weeks in the community. She has well-healed wounds and good range of elbow movement. Conclusions Cefiderocol’s novel mode of cell entry is effective against MDR Gram-negative bacteria with reduced toxicity compared with other last line antibiotics. Our case demonstrates that cefiderocol may be useful as therapy for patients with limited treatment options due to antimicrobial resistance. |
Author | Wareham, David W Cherian, Benny P Mabayoje, Diana A Tan, Mei Gie Meiqi NicFhogartaigh, Caoimhe |
AuthorAffiliation | 2 Antimicrobial Research Group, Blizard Institute, Queen Mary University of London , London, UK 1 Division of Infection, Barts Health NHS Trust , London, UK |
AuthorAffiliation_xml | – name: 2 Antimicrobial Research Group, Blizard Institute, Queen Mary University of London , London, UK – name: 1 Division of Infection, Barts Health NHS Trust , London, UK |
Author_xml | – sequence: 1 givenname: Diana A surname: Mabayoje fullname: Mabayoje, Diana A email: dmabayoje@nhs.net organization: Division of Infection, Barts Health NHS Trust, London, UK – sequence: 2 givenname: Caoimhe surname: NicFhogartaigh fullname: NicFhogartaigh, Caoimhe organization: Division of Infection, Barts Health NHS Trust, London, UK – sequence: 3 givenname: Benny P surname: Cherian fullname: Cherian, Benny P organization: Division of Infection, Barts Health NHS Trust, London, UK – sequence: 4 givenname: Mei Gie Meiqi surname: Tan fullname: Tan, Mei Gie Meiqi organization: Antimicrobial Research Group, Blizard Institute, Queen Mary University of London, London, UK – sequence: 5 givenname: David W orcidid: 0000-0003-4331-5224 surname: Wareham fullname: Wareham, David W organization: Division of Infection, Barts Health NHS Trust, London, UK |
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Cites_doi | 10.1016/j.ijantimicag.2009.10.024 10.1016/j.jgar.2020.09.019 10.1093/cid/ciz826 10.1093/cid/ciz827 10.1099/jmm.0.063925-0 10.1016/j.ijantimicag.2018.11.007 10.3389/fmicb.2019.00930 10.1093/ofid/ofaa150 10.1016/S1473-3099(20)30731-3 10.1128/AAC.00230-11 10.1016/j.jgar.2020.01.001 10.1128/AAC.01872-19 10.1016/S1473-3099(20)30796-9 10.1007/s40265-019-1055-2 10.1093/ofid/ofaa185 10.1016/S1473-3099(18)30721-7 10.1016/j.ijantimicag.2012.09.008 10.1016/S1473-3099(18)30554-1 10.1086/590568 |
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Background
Cefiderocol is a recently licensed novel siderophore-conjugated cephalosporin stable to hydrolysis by serine and MBLs. It has been... Cefiderocol is a recently licensed novel siderophore-conjugated cephalosporin stable to hydrolysis by serine and MBLs. It has been successfully used to treat... BACKGROUNDCefiderocol is a recently licensed novel siderophore-conjugated cephalosporin stable to hydrolysis by serine and MBLs. It has been successfully used... |
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Title | Compassionate use of cefiderocol for carbapenem-resistant Acinetobacter baumannii prosthetic joint infection |
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