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. 2024 May 16;13(5):453.
doi: 10.3390/antibiotics13050453.

Role of Cefiderocol in Multidrug-Resistant Gram-Negative Central Nervous System Infections: Real Life Experience and State-of-the-Art

Alessio Sollima  1 , Francesco Rossini  1 , Paola Lanza  2 , Carlo Pallotto  3 , Marianna Meschiari  4 , Ivan Gentile  5 , Roberto Stellini  1 , Angelica Lenzi  1 , Alice Mulé  1 , Francesca Castagna  1 , Silvia Lorenzotti  2 , Silvia Amadasi  2 , Evelyn Van Hauwermeiren  2 , Barbara Saccani  2 , Benedetta Fumarola  2 , Liana Signorini  2 , Francesco Castelli  1   2 , Alberto Matteelli  1   2
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Role of Cefiderocol in Multidrug-Resistant Gram-Negative Central Nervous System Infections: Real Life Experience and State-of-the-Art

Alessio Sollima et al. Antibiotics (Basel). .

Abstract

Cefiderocol is a new molecule effective against multidrug-resistant (MDR) Gram-negative pathogens. Currently, there is limited evidence regarding the use of cefiderocol in central nervous system (CNS) infections. Data on the cerebrospinal fluid penetration rate of cefiderocol are limited and heterogeneous, and there is no consensus on the dosing scheme of cefiderocol to penetrate the blood-brain barrier. We present a case series and a literature review of CNS infections caused by MDR pathogens that were treated with cefiderocol: some of these patients were treated with different dose schemes of cefiderocol and underwent therapeutic drug monitoring both on plasma and cerebrospinal fluid (CSF). The CSF penetration rates and the clinical outcomes were evaluated.

Keywords: CNS infections; cefiderocol; central nervous system; gram-negative; neurosurgical device infections; therapeutic drug monitoring.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Timeline of nosocomial infections and antimicrobial therapy, Case 1. Abbreviations: CRBSI: catheter-related bloodstream infection; CSF: cerebral spinal fluid; MER: meropenem; AMP: ampicillin; FOS: fosfomycin; AMIK IT: amikacin intrathecal; CFD: cefiderocol; CIP: ciprofloxacin; TOB: tobramycin; VAN: vancomycin; VPS: ventriculoperitoneal shunt; XDR-P: extensively drug-resistant P. aeruginosa.
Figure 2
Figure 2
Timeline of nosocomial infections and antimicrobial therapy, Case 3. Abbreviations: AMP/SUL: ampicillin/sulbactam; BC: blood culture; CEF: ceftriaxone; CSF: cerebral spinal fluid; MER: meropenem; EVD: external ventricular device; SAH: subarachnoid hemorrhage; LIN: linezolid; CRAB: carbapenem-resistant A. baumannii.
Figure 3
Figure 3
Timeline of nosocomial infections and antimicrobial therapy, Case 4. Abbreviations: BC: blood culture; DTR-P: difficult to treat P. aeruginosa; CEF/TZB: ceftolozane/tazobactam; FOS: fosfomycin; CFT/AVI: ceftazidime/avibactam; VJ: ventriculo-jugular; JA: jugulo-atrial; COL: colistin; AKI: acute kidney injury.
Figure 4
Figure 4
Timeline of nosocomial infections and antimicrobial therapy, Case 5. Abbreviations: CSF: cerebral spinal fluid; AMP: ampicillin; IOC: intraoperative culture; MDR-P: multidrug-resistant P. aeruginosa; KP: K. pneumoniae; MER: meropenem; LIN: linezolid; FLU: fluconazole; CFZ/AVI: ceftazidime/avibactam; AZT: aztreonam; FOS: fosfomycin; CFD: cefiderocol.
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