Real-world experience with cefiderocol therapy for and other multidrug resistant gram-negative infections within the Veterans Health Administration, 2019-2022.

Chou A, Ramsey D, Amenta E, Trautner BW. Real-world experience with cefiderocol therapy for and other multidrug resistant gram-negative infections within the Veterans Health Administration, 2019-2022. Antimicrobial stewardship & healthcare epidemiology : ASHE. 2023 May 4; 3(1):e90.

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

OBJECTIVE: Single-center and regional studies have reported outcomes after treatment with cefiderocol, a novel siderophore cephalosporin. We report on real-world use, clinical outcomes, and microbiological outcomes with cefiderocol therapy within the Veterans' Health Administration (VHA). DESIGN: Prospective, observational descriptive study. SETTING: Veterans' Health Administration, 132 sites across the United States, during 2019-2022. PATIENTS: This study included patients admitted to any VHA medical center who received cefiderocol for 2 days. METHODS: Data were obtained from the VHA Corporate Data Warehouse and through manual chart review. We extracted clinical and microbiologic characteristics and outcomes. RESULTS: In total, 8,763,652 patients received 1,142,940,842 prescriptions during the study period. Of these, 48 unique individuals received cefiderocol. The median age of this cohort was 70.5 years (IQR, 60.5-74), and the median Charlson comorbidity score was 6 (IQR, 3-9). The most common infectious syndromes were lower respiratory tract infection in 23 patients (47.9%) and urinary tract infection in 14 patients (29.2%). The most common pathogen cultured was in 30 patients (62.5%). The clinical failure rate was 35.4% (17 of 48), and 15 (88.2%) of these 17 patients died within 3 days of clinical failure. The 30-day and 90-day all-cause mortality rates were 27.1% (13 of 48) and 45.8% (22 of 48), respectively. The 30-day and 90-day microbiologic failure rates were 29.2% (14 of 48) and 41.7% (20 of 48), respectively. CONCLUSIONS: In this nationwide VHA cohort clinical and microbiologic failure occurred in > 30% of patients treated with cefiderocol, and > 40% of these died within 90 days. Cefiderocol is not widely used, and many of the patients who received it had substantial comorbidities.