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Multicenter Study
. 2025 Jan;90(1):106376.
doi: 10.1016/j.jinf.2024.106376. Epub 2024 Dec 15.

Real-world multicentre study of cefiderocol treatment of immunocompromised patients with infections caused by multidrug-resistant Gram-negative bacteria: CEFI-ID

Sarah Soueges  1 , Emmanuel Faure  2 , Perrine Parize  3 , Fanny Lanternier-Dessap  3 , Hervé Lecuyer  4 , Anne Huynh  5 , Guillaume Martin-Blondel  6 , Benjamin Gaborit  7 , Mathieu Blot  8 , Arnaud Magallon  9 , Elodie Blanchard  10 , Xavier Brousse  11 , Marin Lahouati  12 , Anne-Sophie Brunel  13 , Eloise Le Banner  14 , François Camelena  15 , Romaric Larcher  16 , Alix Pantel  17 , Giovanna Melica  18 , Keyvan Razazi  19 , François Danion  20 , Frederic Schramm  21 , Oana Dumitrescu  22 , Baptiste Hoellinger  20 , Florence Ader  23 ; G2I (Groupe Immunodepression et Infections) network
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Free article
Multicenter Study

Real-world multicentre study of cefiderocol treatment of immunocompromised patients with infections caused by multidrug-resistant Gram-negative bacteria: CEFI-ID

Sarah Soueges et al. J Infect. 2025 Jan.
Free article

Abstract

Introduction: The increase in the population of immunocompromised patients due to advances in management of end-stage diseases and transplants poses challenges in treating infections caused by multi-drug resistant (MDR) pathogens. Cefiderocol (FDC), a siderophore cephalosporin, has shown efficacy against carbapenem-resistant Gram-negative bacteria.

Methods: This retrospective multicentre study investigated the real-world use of FDC in 114 immunocompromised adults treated for MDR infections in 12 French hospitals (June 2020-November 2023). Clinical and microbiological outcomes, including infection cure, relapse, as well as mortality, and resistance acquisition, were assessed at days 28 and 90. Antibiotic prescription compliance with current guidelines was investigated.

Results: At day 28, clinical success was achieved in 53.3% of cases, and overall mortality was 37.7%, consistent with other studies (33-37%). Infection-related mortality accounted for 25.4%. Relapse occurred in 17.5% of patients by day 28, rising by an additional 9.8% among survivors by day 90. Resistance acquisition was observed in two cases at day 28 (Pseudomonas aeruginosa and Stenotrophomonas maltophilia) and in three additional cases by day 90. FDC was used as monotherapy in 49.1% of cases, with a median treatment duration of 10 days. Nearly 25% of strains collected in FDC-treated patients were susceptible to best-practice alternatives.

Conclusion: These findings highlight FDC's utility in difficult-to-treat infections, particularly S. maltophilia, but the high relapse rate and resistance acquisition underscore the need for careful monitoring, adherence to guidelines, and reconsideration of empirical use to prevent resistance and improve outcomes in fragile populations.

Keywords: Cefiderocol; Immunocompromised patients; Multi drug resistant gram-negative bacteria; Stenotrophomonas maltophilia.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SS received travel grants from Shionogi.

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