TOPLINE:

Cefiderocol was effective in multiple gram-negative bacterial infections, particularly in patients with complex clinical profiles and prior antibiotic exposure, with no significant difference in 30-day survival between monotherapy and combination therapy regimens.

METHODOLOGY:

• Researchers conducted a retrospective study to characterize patients treated with cefiderocol for various gram-negative bacterial infections, compare 30-day survival between monotherapy and combination therapy, and identify predictors of 30-day mortality.
• They assessed 239 patients treated with cefiderocol (median age, 68 years; 64.9% male) across 17 Italian hospitals from January 2021 to February 2023.
• Data were collected for gram-negative bacterial infections, including bloodstream infections, hospital-acquired pneumonia, ventilator-associated pneumonia, complicated urinary tract infections, complicated intra-abdominal infections, and bone and joint infections.

TAKEAWAY:

• Among patients treated with cefiderocol, the most common infections were bloodstream infections (49.8%), followed by ventilator-associated pneumonia (20.1%), hospital-acquired pneumonia (20.1%), and complicated urinary tract infections (12.1%).
• The predominant pathogen was Acinetobacter baumannii (64.8%), followed by Klebsiella species (23.0%), Pseudomonas aeruginosa (17.6%), and Stenotrophomonas maltophilia (8.8%).
• The probability of 30-day survival was 71% (95% CI, 65-76), with no significant differences between monotherapy and combination therapy.
• Independent predictors of greater 30-day mortality included receiving two or three prior lines of antibiotic therapy before cefiderocol (P = .051 and P = .013, respectively), SARS-CoV-2 coinfection (P < .001), and infection with New Delhi metallo-beta-lactamase-producing Klebsiella species (P = .001).

IN PRACTICE:

“Multiple previous antibiotic lines, SARS-CoV-2 coinfection, and isolation of NDM [New Delhi metallo-beta-lactamase]-producing Klebsiella spp. are critical predictors of increased mortality in patients with GNBIs [gram-negative bacterial infections] treated with cefiderocol, suggesting that the management of such conditions should account for those factors in order to optimize treatment strategies,” the authors of the study wrote.

SOURCE:

The study was led by Matteo Augello, PhD, University of Milan, Milan, Italy. It was published online on December 06, 2025, in the International Journal of Infectious Diseases.

LIMITATIONS:

The study was limited by its retrospective design, which may have introduced selection bias, data incompleteness, and difficulty in controlling for confounders. The absence of a comparison group treated with agents other than cefiderocol may have limited the ability to evaluate comparative effectiveness. Additionally, the relatively small sample size for each pathogen may have limited the ability to assess mortality differences between monotherapy and combination therapy by bacterial isolate.

DISCLOSURES:

The study was supported by funding from the EU’s Horizon 2020 Research and Innovation Program. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.