Role of Cefiderocol in the Treatment of Carbapenem-Resistant Nonfermenting Gram-Negative Bacilli (Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia) Infections: An Expert Statement
Abstract
Introduction: Infections caused by nonfermenting gram-negative bacilli (NF-GNB), particularly Acinetobacter baumannii, Stenotrophomonas maltophilia, and Pseudomonas aeruginosa, are associated with high morbidity and mortality, especially among critically ill or immunocompromised patients. The rise of multidrug resistance has rendered many first-line antibiotics ineffective, highlighting the need for novel agents such as cefiderocol, a siderophore cephalosporin with unique pharmacokinetics and broad in vitro activity against resistant gram-negative pathogens.
Methods: A multidisciplinary panel of French experts in infectious diseases, microbiology, pharmacology, and intensive care reviewed the available evidence and clinical experience of cefiderocol. Using a structured consensus process, the group developed pragmatic, expert-based recommendations for its use against A. baumannii, S. maltophilia, and P. aeruginosa, considering clinical scenarios, resistance mechanisms, pharmacokinetic/pharmacodynamic (PK/PD) optimization, and practical implementation.
Results: Cefiderocol demonstrates potent in vitro activity against NF-GNB, including colistin- and imipenem-resistant isolates. Clinical success, however, depends on optimized PK/PD exposure, particularly in high-inoculum infections or patients with augmented renal clearance. Cohort studies and meta-analyses suggest lower mortality and markedly reduced nephrotoxicity compared with colistin-based regimens in A. baumannii…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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