Journal Article

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

Diarra, Ava, Taar, Nicolas, Sayre, Naomi, Baldolli, Aurélie, Dacquet, Vincent, Jaffal, Karim, Asquier-Khati, Antoine, Ferry, Tristan, Escaut, Lelia, de Lastours, Victoire, Patoz, Pierre, Gazeau, Pierre, Bermejo, Messaline, Wille, Heidi, Senneville, Eric, Valentin, Benjamin, Costescu Strachinaru, Diana, Lefevre, Benjamin, Larcher, Romaric, Deconinck, Laurène, Bleibtreu, Alexandre, Robineau, Olivier, Courjon, Johan, Rouzic, Nicolas, Degrendel, Maxime, Eberl, Isabelle

2025

Overview

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.

• Publisher: MDPI AG,MDPI
• Subject: Antibacterial agents / Antibiotics / Antimicrobial agents / Biofilms / bone and joint infection / Carbapenemase / Care and treatment / cefiderocol / Cephalosporins / Comorbidity / Diarrhea / Drug resistance / Failure / Gastrointestinal diseases / Gram-negative bacilli / Gram-positive bacteria / Human health and pathology / Infection / Infections / Infectious diseases / Iron / Joint diseases / Life Sciences / Mortality / Multidrug resistance / outcome / Pathogens / Patients / Pharmaceutical sciences / Pharmacology / Pneumonia / Rhumatology and musculoskeletal system / Santé publique et épidémiologie / Side effects / Surgery / tolerance