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. 2025 Apr 8;14(4):388.
doi: 10.3390/antibiotics14040388.

Real-Life Cefiderocol Use in Bone and Joint Infection: A French National Cohort

Ava Diarra  1   2 , Maxime Degrendel  3 , Isabelle Eberl  4 , Tristan Ferry  5   6 , Karim Jaffal  7 , Lelia Escaut  8 , Antoine Asquier Khati  9 , Nicolas Taar  10 , Johan Courjon  11   12 , Laurène Deconinck  13 , Benjamin Lefevre  14   15 , Aurélie Baldolli  16 , Messaline Bermejo  17 , Alexandre Bleibtreu  18 , Vincent Dacquet  19 , Victoire de Lastours  20 , Pierre Gazeau  21 , Romaric Larcher  22 , Pierre Patoz  23 , Olivier Robineau  1   24   25 , Nicolas Rouzic  26 , Naomi Sayre  27 , Diana Isabela Costescu Strachinaru  28 , Benjamin Valentin  29 , Heidi Wille  30 , Eric Senneville  1
Affiliations

Real-Life Cefiderocol Use in Bone and Joint Infection: A French National Cohort

Ava Diarra et al. Antibiotics (Basel). .

Abstract

Background: Cefiderocol (CFD) is a novel siderophore cephalosporin developed for the treatment of infections involving multidrug-resistant (MDR) Gram-negative bacilli (GNB) infections (1-3). For bone and joint infections (BJIs), the use of CFD is currently neither part of its market authorization nor recommended, and has not yet been assessed by large-scale studies. Objectives: To fill the scarcity of data regarding the use of CFD in BJIs, we aimed to describe patients' and infection characteristics along with the outcomes of the infection. Methods: We conducted a retrospective observational multicenter study in 22 French centers from January 2019 to December 2023. Results: From January 2019 to December 2023, 45 patients were included. Patients were mainly males (73%) with a median age of 62 years (interquartile range [IQR] 29), and a median Charlson comorbidity index of 3. Implant-related infections (20) were the most prominent, accounting for 44% of the cases. Carbapenemase-producing GNB were involved in 74% of the cases (n = 17/23), among which Pseudomonas aeruginosa accounted for 38% of these cases. Most patients received 6 g of CFD per day. CFD was used in combination with an antibiotic in 40 out of 45 cases (89%). The median duration of CFD treatment was 34 days. Seven patients (16%) experienced side effects, mainly gastro-intestinal disorders, including three (7%) who induced treatment cessation. Infection control included surgery in 37 (82%) patients. Failures and deaths occurred, respectively, in 22 (49%) and 10 (22%) cases. Conclusions: Our results suggest that CFD may be an alternative in MDR-GNB infections with limited therapeutic options.

Keywords: Gram-negative bacilli; bone and joint infection; cefiderocol; outcome; tolerance.

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Conflict of interest statement

E.S. declares honoraria and consultancy fees from Shionogi. O.R. reported receiving personal fees and nonfinancial support from Gilead, MSD, ViiV, Shionogi, Corevio, and Pfizer outside the submitted work. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Origins of microbiological sampling (a) and isolates classification (b).
Figure 2
Figure 2
Isolates in detail.
Figure 3
Figure 3
Resistance patterns (a) and carbapenemase classes (b) for 23 and 17 GNB strains, respectively.
Figure 4
Figure 4
Antibiotic combined with cefiderocol (a) and reason for cefiderocol cessation (b).
See this image and copyright information in PMC

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