Cefiderocol Versus Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii Complex Bloodstream Infections: A Retrospective, Propensity-Score Adjusted, Monocentric Cohort Study
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..
| Medienart: |
Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
Infectious diseases and therapy - 12(2023), 8 vom: Aug., Seite 2147-2163 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bavaro, Davide Fiore [VerfasserIn] |
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| Links: |
Volltext [lizenzpflichtig] |
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| Themen: |
Antimicrobial resistance |
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| Anmerkungen: |
© The Author(s) 2023 |
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| doi: |
10.1007/s40121-023-00854-6 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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OLC2145588574 |
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| 245 | 1 | 0 | |a Cefiderocol Versus Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii Complex Bloodstream Infections: A Retrospective, Propensity-Score Adjusted, Monocentric Cohort Study |
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| 520 | |a 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. | ||
| 650 | 4 | |a Antimicrobial resistance | |
| 650 | 4 | |a Bloodstream infections | |
| 650 | 4 | |a Carbapenem-resistant | |
| 650 | 4 | |a Cefiderocol | |
| 650 | 4 | |a Colistin | |
| 700 | 1 | |a Papagni, Roberta |4 aut | |
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| 700 | 1 | |a Brindicci, Gaetano |4 aut | |
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| 700 | 1 | |a Ronga, Luigi |4 aut | |
| 700 | 1 | |a Mosca, Adriana |4 aut | |
| 700 | 1 | |a Pomarico, Francesco |4 aut | |
| 700 | 1 | |a Dell’Aera, Maria |4 aut | |
| 700 | 1 | |a Stufano, Monica |4 aut | |
| 700 | 1 | |a Dalfino, Lidia |4 aut | |
| 700 | 1 | |a Grasso, Salvatore |4 aut | |
| 700 | 1 | |a Saracino, Annalisa |4 aut | |
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