A descriptive case series of PK/PD target attainment and microbiological outcome in critically ill patients with documented severe XDR Acinetobacter baumannii BSI and/or VAP treated with cefiderocol
Abstract
OBJECTIVES
To explore the relationship between cefiderocol pharmacokinetic/pharmacodynamic (PK/PD) target attainment and microbiological outcome in critically ill patients affected by extensively drug-resistant Acinetobacter baumannii (XDR-AB) bloodstream infection (BSI) and/or ventilator-associated pneumonia (VAP).
METHODS
Patients who received compassionate use of cefiderocol for treating documented XDR-AB infections at the intensive care unit of the IRCCS Azienda Ospedaliero-Universitaria of Bologna and who underwent therapeutic drug monitoring (TDM) from 15 March to 30 April 2021 were retrospectively assessed. Cefiderocol trough concentration (Cmin) was determined at steady-state, and the free fraction (fCmin) was calculated according to a plasma protein binding of 58%. The fCmin/MIC ratio was selected as PD parameter of cefiderocol efficacy, and defined as optimal if ≥ 4, quasi-optimal if between 1 and 4, and suboptimal if < 1. The association between fCmin/MIC and microbiological outcome was assessed.
RESULTS
Thirteen patients treated with cefiderocol for the management of XDR-AB infections (six BSIs plus VAP, 5 VAP and 2 BSI) were retrieved. fCmin/MIC ratios were suboptimal in 3 cases (23%), and quasi-optimal or optimal in 5 cases each (39%). Microbiological failure occurred in 7 cases (54%; six with VAP and one with both VAP and BSI). Microbiological failure occurred in 80% of patients with suboptimal fCmin/MIC compared to 29% of those achieving optimal or…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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