Cefiderocol Versus Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii Complex Bloodstream Infections: A Retrospective, Propensity-Score Adjusted, Monocentric Cohort Study

Autor: Davide Fiore Bavaro, Roberta Papagni, Alessandra Belati, Lucia Diella, Antonio De Luca, Gaetano Brindicci, Nicolò De Gennaro, Francesco Di Gennaro, Federica Romanelli, Stefania Stolfa, Luigi Ronga, Adriana Mosca, Francesco Pomarico, Maria Dell’Aera, Monica Stufano, Lidia Dalfino, Salvatore Grasso, Annalisa Saracino
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Infectious Diseases and Therapy, Vol 12, Iss 8, Pp 2147-2163 (2023)
Druh dokumentu: article
ISSN: 2193-8229
2193-6382
DOI: 10.1007/s40121-023-00854-6
Popis: Abstract Introduction Bloodstream infections (BSI) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) are associated with high mortality with limited treatment. The aim of this study is to compare effectiveness and safety of colistin-based versus cefiderocol-based therapies for CRAB-BSI. Methods This is a retrospective observational study enrolling patients with monomicrobial CRAB-BSIs treated with colistin or cefiderocol from 1 January 2020, to 31 December 2022. The 30-day all-cause mortality rate was the primary outcome. A Cox regression analysis was performed to identify factors independently associated with mortality. A propensity score analysis using inverse probability of treatment weighting (IPTW) was also performed. Results Overall 118 patients were enrolled, 75 (63%) and 43 (37%) treated with colistin- and cefiderocol-based regimens. The median (q1–q3) age was 70 (62–79) years; 70 (59%) patients were men. The 30-day all-cause mortality was 52%, significantly lower in the cefiderocol group (40% vs 59%, p = 0.045). By performing a Cox regression model, age (aHR = 1.03, 95% CI 1.00–1.05), septic shock (aHR = 1.93, 95% CI 1.05–3.53), and delayed targeted therapy (aHR = 2.42, 95% CI 1.11–5.25) were independent predictors of mortality, while cefiderocol-based therapy was protective (aHR = 0.49, 95% CI 0.25–0.93). The IPTW-adjusted Cox analysis confirmed the protective effect of cefiderocol (aHR = 0.53, 95% CI 0.27–0.98). Conclusions Cefiderocol may be a valuable treatment option for CRAB-BSI, especially in the current context of limited treatment options.
Databáze: Directory of Open Access Journals
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