677. Systematic Review of the Early Use Experince of Cefiderocol in Real World Practice
Authors: Viale Pierluigi , Tascini Carlo , Dinh Aurelien , Longshaw Christopher M , Fitzgerald Anita C , Wood Hannah , Patterson Jacoby Vivien M , Watkins Deborah , Wilson Katy , Gill Karan 
Published: December 2022

Abstract

Background
Gram-negative bacteria (GNB) with resistance to carbapenems is a growing global public health concern. The World Health Organisation have listed three priority GNB pathogens for the development of novel antimicrobial agents; Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacterales. The purpose of this systematic review (SR) was to report evidence on the use of cefiderocol (FDC), a siderophore cephalosporin, for patients with GNB infections in compassionate use or expanded access settings.

Methods
Searches were undertaken to identify relevant evidence up to December 2021. Two independent reviewers screened the records retrieved for relevance to the SR with disagreements adjudicated by a third reviewer. Patients receiving FDC in a compassionate use, expanded access setting or those with limited treatment options for the treatment of GNB infection were eligible. Eligible case reports and case series were assessed for quality using predefined tools and data were extracted (by a single reviewer with data checking performed by a second reviewer), tabulated and summarised.

Results
Forty-four studies (n=150 patients) were identified reporting the use of FDC; 3 case series studies and 41 case reports. The most commonly reported pathogens were P. aeruginosa (41.3%), A. baumannii (36.0%) and A. xylosoxidans (14.3%). The diagnoses varied widely across the included patients. All patients were administered FDC at a dose between 750 mg and 2 g per day on various schedules, adjusted for renal function for between one and six weeks.
Clinical cure was reported in 137 patients using author-specified definitions with 74 patients (54.0%) reporting clinical cure and 18 (13.1%) reporting failure. Microbiological eradication was reported in 78 patients of whom 56 (71.8%) reported success, while 22 (28.2%) reported failure. For mortality (n=123) 80 patients (65.0%) remained alive at the end of treatment, while 43 (35.0%) died. Adverse event (AE) data was reported for 53 patients of whom 13 (24.5%) reported AEs, while 40 (75.5%) did not. See Table 1.0.

Conclusion
FDC is a promising therapy for patients with GNB infections with limited treatment options. Real world practice shows a high microbiological eradication rate and a small number of AEs.

Disclosures
Carlo Tascini, n/a, Shionogi: Grant/Research Support Aurelien Dinh, Professor of Infectious Disease, Shionogi: Advisor/Consultant|Shionogi: Board Member Christopher M. Longshaw, PhD, Shionogi: Employee Anita C. Fitzgerald, MPH, Shionogi: Shionogi commissioned York Health Economics Consortium of which I am an associate, to conduct the systematic review we are submitting to IDWeek Hannah Wood, BA MA, Shionogi: Shionogi commissioned York Health Economics Consortium of which I am an employee, to conduct the systematic review we are submitting to IDWeek Jacoby Vivien M. Patterson, MA Cantab, MB BChir, FFPH MD, Shionogi: Shionogi commissioned York Health Economics Consortium of which I am an associate, to conduct the systematic review we are submitting to IDW Deborah Watkins, MSc, Shionogi: Shionogi commissioned York Health Economics Consortium of which I am an employee, to conduct the systematic review we are submitting to IDWeek Katy Wilson, LLM, Shionogi: Shionogi commissioned York Health Economics Consortium of which I am an employee to conduct the systematic review we are submitting to IDWeek Karan Gill, Master of Science, Shionogi: Employee.