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Cefiderocol/colistin Neutropenia: case report

A 78-year-old woman developed neutropenia during treatment with cefiderocol and colistin for endocarditis [routes not stated]. She received cefiderocol on a compassionate basis. The woman was hospitalised for respiratory and urological management. Her medical history was significant for hydronephrosis, spontaneous ureteric haematoma, ischaemic heart disease, aortic stenosis, cerebral infarction and she was in remission from breast cancer. On admission, she was ventilated and her blood cultures grew drug-resistant Pseudomonas aeruginosa susceptible to colistin, gentamicin and amikacin. She also had rectal colonosation with OXA-23/OXA-51 Acinetobacter baumannii and OXA-48 Klebsiella pneumonia. She started receiving empirical treatment with colistin 9MU loading dose followed by 3MU 3 times a day, subsequently changed to 4.5MU twice a day along with gentamicin. She developed sepsis and received veno-venous haemfiltration. On days 3, 5 and 7 blood cultures again grew Pseudomonas aeruginosa. On day 5, gentamicin was replaced with meropenem. Her sepsis resolved and her antibiotic therapy was stopped. On days 22 and 27, her blood cultures again grew Pseudomonas aeruginosa. She again started treatment with gentamicin and colistin. The Pseudomonas aeruginosa isolate was reported as intermediately resistant to gentamicin. Hence, the treatment with gentamicin was changed to meropenem. On days 56, 62 and 68, her blood culture again grew Pseudomonas aeruginosa. It was decided to perform valve surgery and additional active antibiotics to control bacteraemia prior to the surgery. Hence, she started receiving cefiderocol 2g over 3 hours 3 times a day for the first 2 days, and then 2g twice daily on compassionate basis from day 83. She continued receiving meropenem and colistin. On day 85, aortic valve replacement was performed. After the sixth dose of cefiderocol, her blood cultures were negative. One week after surgery, meropenem was stopped, but she continued receiving cefiderocol and colistin for an additional 3 weeks. During the last 4 days of antibiotic treatment, her neutrophil count fell to 0.2 x 109/L. The woman’s treatment with cefiderocol and colistin were discontinued. Her neutrophil count returned to the normal range within a few days after discontinuation of antibiotics. Neutropenia was considered with either cefiderocol or colistin being the most likely potential cause [duration of treatments to reaction onset not stated]. Edgeworth JD, et al. Compassionate Use of Cefiderocol as Adjunctive Treatment of Native Aortic Valve Endocarditis Due to Extremely Drug-resistant Pseudomonas aeruginosa. Clinical Infectious Diseases 68: 1932-1934, No. 11, 1 Jun 2019. Available from: URL: http://doi.org/10.1093/cid/ciy963

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Reactions 29 Aug 2020 No. 1819