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Acute renal injury, minimal drop in neutrophil count and off-label use: 3 case reports In a case series, three men were described, of whom a 64-year-old man and a 62-year-old man developed acute renal injury during treatment with colistin for various bacterial infections and a 29-year-old man exhibited minimal drop in neutrophil count following an off-label treatment with cefiderocol for osteomyelitis [routes not stated]. Case 1: A 29-year-old man, who had polytrauma after a motorcycle accident, underwent surgery with external fixation of a thirddegree open fracture of the tibia. He had been receiving treatment with cefazolin, amikacin and piperacillin/tazobactam. At the time of repatriation, he developed an early postoperative implant-associated polymicrobial wound infection. On further examination, he was diagnosed with carbapenemase-producing Pseudomonas aeruginosa (VIM), Acinetobacter baumannii (OXA-23) and Enterobacter cloacae (KPC) infections. He was started on vancomycin, tobramycin, meropenem, aztreonam [Azactam], tigecycline and fosfomycin. He underwent multiple surgeries with removal of the external fixation and osteosynthesis of the tibia. Further examination confirmed the diagnosis of acute osteomyelitis. Following removal of all foreign implants, he was started on an off-label treatment with cefiderocol 2g thrice daily for 2 weeks. Additionally, ceftazidime-avibactam and colistin were initiated and remained for 4 weeks. There were no significant adverse events were noted during treatment. However, a minimal drop in neutrophil count (1.13 x 109/L) secondary to cefiderocol treatment, which were normalised at a consecutive control. Following an antibiotic-free interval of 2 weeks, there was no evidence for persistent infection. He underwent a definite surgery with implantation of an internal fixation device after receiving preoperative antibiotic prophylaxis with single-dose colistin, ceftazidime-avibactam and cefiderocol. Thereafter, there were no clinical signs of recurrent infection and he was discharged. At 8 months of follow-up, there were no clinical or radiological signs of recurrent infection at the surgical site. Case 2: A 64-year-old man, who had polytrauma after falling off a ladder, underwent transpedicular stabilisation Th11–L3 and external fixation of the femur. Thereafter, an internal fixation of a trans/subtrochanteric femoral fracture and osteosynthesis of a medial malleolus ankle fracture and of a periprosthetic fracture of the tibia were performed. At the time of repatriation, he was found to have an early postoperative implant associated infection of the spine with A. baumannii infection. He was treated with amoxicillin/ clavulanic acid[Amoxicillin/Clavulansaure], vancomycin, meropenem, tigecycline, aztreonam and avibactam/ceftazidime. Thereafter, he was started on an off-label treatment with cefiderocol 2g thrice daily. Additionally, colistin 4.5 Mio IE every 12h. was initiated following surgical revision with removal of the osteosynthesis from the spine. On day-12 of the treatme