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Daniele Roberto Giacobbe,1,2 Eugenio Ciacco,3 Corrado Girmenia,4 Federico Pea,5,6 Gian Maria Rossolini,7,8 Giovanni Sotgiu,9 Carlo Tascini,10 Mario Tumbarello,11,12 Pierluigi Viale,5,6 Matteo Bassetti1,2 On behalf of the ISGRI-SITA (Italian Study Group on Resistant Infections of the Italian Society of Anti-infective Therapy)1Clinica Malattie Infettive, Ospedale Policlinico San Martino – IRCCS, Genoa, Italy; 2Department of Health Sciences, University of Genoa, Genoa, Italy; 3Pharmacy Unit, S. Salvatore Hospital, ASL1 Abruzzo, L’Aquila, Italy; 4Hematology, Dipartimento Medicina Traslazionale e di Precisione, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy; 5Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; 6University Hospital IRCCS Policlinico Sant’Orsola Bologna, Bologna, Italy; 7Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; 8Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy; 9Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy; 10SOC Malattie Infettive, Azienda Sanitaria Integrata, University of Udine, Udine, Italy; 11Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 12Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, ItalyCorrespondence: Daniele Roberto GiacobbeClinica Malattie Infettive, Ospedale Policlinico San Martino – IRCCS, L.go R. Benzi 10, Genoa 16132, ItalyTel +390105554658Email daniele.roberto.giacobbe@gmail.comAbstract: Infections due to multidrug-resistant Gram-negative bacteria (MDR-GNB), especially when carbapenem resistant, have been very difficult to manage in the last fifteen years, owing to the paucity of dependable therapeutic options. Cefiderocol is a siderophore cephalosporin recently approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) that may have the potential to fill some of the remaining gaps in the treatment of MDR-GNB infections. Among others, cefiderocol demonstrated in vitro activity against carbapenem-resistant Acinetobacter baumannii and metallo-β-lactamases producers. Clinical data from both registrative studies and post-marketing experiences are essential to confirm whether these promises from in vitro studies could readily translate into clinical practice, as well as to delineate the precise place in therapy for cefiderocol for the treatment of MDR-GNB in the near future. Because of its unique potential, it is essential to provide both randomized controlled trials (RCT) and real-life data to improve the ability of clinicians to exploit its benefit in both empirical and targeted treatment of MDR-GNB infections. In this narrative review, we discuss the emerging data from pivotal RCT and initial real-life experiences on the use of cefiderocol for the treatment of MDR-GNB infections.Keywords: cefiderocol, siderophore, Pseudomonas, Acinetobacter, Enterobacterales, antimicrobial resistance |
