650. Cefiderocol use in burn patients admitted to an intensive care unit


 
 
 Cefiderocol is a novel cephalosporin that binds to ferric acid and is moved across the outer membrane of Gram-negative bacilli via iron transport. Once through the outer membrane, cefiderocol is able to exert typical cephalosporin activity. Because of its ‘Trojan horse’-like mechanism of action, cefiderocol is able to elude typical bacterial resistance mechanisms and has activity against multidrug-resistant organisms (MDROs), including Acinetobacter spp. and Pseudomonas spp. While cefiderocol is considered to be relatively safe, it does have the potential to predispose to secondary infection with Clostridioides difficile. We present a case series where cefiderocol was used to treat infections caused by MDROs in burn patients admitted to our burn intensive care unit (BICU).
 
 
 
 A clinical review of patients admitted to the BICU who received cefiderocol between September 2019 and April 2022 was performed.
 
 
 
 Five patients received 6 courses of cefiderocol. Three patients (60%) had flame burns, one patient (20%) had a scald burn, and one patient (20%) had blast injury. The median burn size was 47% TBSA (IQR 31, 60 days). The median time from injury to cefiderocol initiation was 73.5 days (IQR 49.5, 108). The median duration of cefiderocol therapy was 7 days (IQR 7, 16). The most common indications for cefiderocol treatment were pneumonia (33.3%) and bacteremia (33.3%), followed by wound infection (16.7%), and discitis/osteomyelitis (16.7%). Organisms isolated included Escherichia coli (n=2), Enterobacter cloacae (n=1), Acinetobacter baumannii (n=1), and Pseudomonas aeruginosa (n=2). All isolates were carbapenem resistant, and only one isolate was susceptible to amikacin (Acinetobacter baumannii). The 2 E. coli isolates carried a New Delhi metallo-beta lactamase. Two thirds of patients (n=4) achieved a clinical cure with cefiderocol treatment. Three of the 5 patients (60%) died during their hospital stay.
 All patients received appropriate doses of cefiderocol based on the current prescribing recommendations. No patients developed infection with C. difficile as a result of cefiderocol treatment.
 
 
 
 Cefiderocol is a cephalosporin with novel mechanism of action that can be used to treat MDROs in burn patients, with no secondary C. difficile infections observed.
 
 
 
 All Authors: No reported disclosures.
