Cefiderocol therapy among immunocompromised adult patients: a descriptive analysis from a prospective, multicentre cohort study

Purpose: The global rise in infections due to multidrug-resistant Gram-negative bacteria (MDRGNB) infections has disproportionately impacted immunocompromised (IC) hosts. Cefiderocol, a novel siderophore cephalosporin, exhibits potent activity against MDRGNB, but limited data exist on its use in IC patients. This study aimed to describe cefiderocol use in IC patients. Methods: Patients and therapy characteristics were descriptively reported, and outcomes were compared between IC and non-IC patients. Cox regression models were used to identify factors associated with mortality. Results: Among 185 patients, 84 (45.4%) were IC. Similar descriptive rates were observed in IC and non-IC groups regarding indications for cefiderocol use, choice of monotherapy versus combination therapy, or empirical versus targeted treatment. The 28-day clinical cure rates were similar across patients receiving targeted cefiderocol therapy for infection due to Pseudomonas aeruginosa (81%, 17/21), Enterobacterales (77.3%, 17/22) and Acinetobacter baumannii (42%, 21/50). Thirty-day mortality was comparable between IC and non-IC patients (40.8%, 95% confidence interval [CI] 27.9–56.8 vs 33.3%, 95% CI 22.9–46.9; p = 0.5430). In multivariable analysis IC status was not associated with higher mortality. Conclusion: Cefiderocol use in IC patients resulted in clinical outcomes comparable to non-IC patients when treating MDRGNB infections. IC status was not associated with an increased mortality, emphasising the importance of effective antimicrobial therapy. Further investigation is needed to clarify the relative impact of the administered treatment vs. the patients’ clinical condition in influencing the prognosis of Acinetobacter baumannii infections.