Efficacy of cefiderocol- versus colistin-containing regimen for treatment of bacteremic ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii in COVID-19 patients

Abstract

Introduction

ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) in patients hospitalized in intensive care units (ICU) is an important and challenging complication, including in COVID-19 patients. Considering the poor lung penetration of most antibiotics, including intravenous colistin due to the poor PK/PD at the infection site, the choice of the best antibiotic regimen is still being debated.

Methods

this was a single-center, observational study conducted from March 2020 to August 2022, including all patients hospitalized consecutively with VAP and concomitant bloodstream infection due to CRAB in the COVID-ICU. The main goal of the study was to evaluate risk factors associated with survival or death at 30 days from VAP onset. A propensity score for receiving therapy was added to the model.

Results

during the study period, 73 patients who developed VAP and concomitant positive blood cultures caused by CRAB were enrolled in the COVID-ICU. Of these patients, 67 (91.7%) developed septic shock, 42 (57.5%) died at 14 days and 59 (80.8%) died at 30 days. Overall, 54 (74%) patients were treated with a colistin-containing regimen and 19 (26%) with a cefiderocol-containing regimen. COX regression analysis showed that COPD, and age were independently associated with 30-day mortality. Conversely, cefiderocol-containing regimens and the combination of a cefiderocol plus fosfomycin-containing regimen were independently associated with 30-day survival, as confirmed by propensity score analysis.

Conclusions

this real-life study in patients with bacteremic VAP caused by CRAB provides useful suggestions for clinicians, showing a possible benefit of cefiderocol and its association with fosfomycin.