Effectiveness of Cefiderocol in Treating Bloodstream Infection
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Reviewed & Translated by Dat Tien Nguyen, B.A, ScM.
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Posted on March 27th, 2026
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Globally, bloodstream infection is a major concern and it imposes a heavy burden on the healthcare system. More alarmingly, with the development and proliferation of antimicrobial resistance bacteria, it has become significantly more challenging to treat these infections. Cefiderocol is a new antibiotic that has been approved to be used in the United States and Europe in 2020. A study that inspected its usage to treat bloodborne infection had recently been published in the Lancet journal.
Funding Source(s): The University of Queensland, Shionogi; The Henderson Foundation; and the National Medical Research Council (Singapore).
The clinical study was conducted in 17 hospitals located in Australia, Malaysia, Singapore, Taiwan, Thailand, and Türkiye. The trial included 504 patients who had been hospitalized with bacterial bloodstream infection. Urinary tract infection, intra-abdominal infection, and line infection were the most common primary source of subsequent bloodstream infection, each accounting for roughly 20% of cases. Blood culture showed that Escherichia coli was the most common microbiological cause - accounting for one-third of all cases. Klebsiella pneumoniae was the close second, responsible for around 30% of cases.
The patients were randomly assigned to be treated intravenously with either 2 g of cefiderocol every 8 hours or a standard-of-care antibiotic. This control course of treatment can include up to 3 antimicrobial agents which are active against gram-negative bacilli. Cefiderocol is a siderophore cephalosporin that can bind to iron in order to enter the bacterial cell. At the active site, the beta lactam chain of cefiderocol can inhibit the bacterial cell wall synthesis process, making it susceptible to lysis due to osmosis.
14 days after treatment initiation, the researchers found that the cefiderocol was equally effective to standard treatment at preventing death in patients affected with bloodstream infection. Additionally, cefiderocol was comparable with other antibiotics at clearing bacteria from the bloodstream and targeting carbapenem-resistant pathogens. The researchers noted that the mortality rate in patients treated with cefiderocol is higher than the control group if they were infected with carbapenem-resistant Acinetobacter spp.; it is not clear why this happened. Further investigation should consider coupling cefiderocol to beta-lacatamase inhibitor in order to improve its effectiveness.
Funding Source(s): The University of Queensland, Shionogi; The Henderson Foundation; and the National Medical Research Council (Singapore).
The clinical study was conducted in 17 hospitals located in Australia, Malaysia, Singapore, Taiwan, Thailand, and Türkiye. The trial included 504 patients who had been hospitalized with bacterial bloodstream infection. Urinary tract infection, intra-abdominal infection, and line infection were the most common primary source of subsequent bloodstream infection, each accounting for roughly 20% of cases. Blood culture showed that Escherichia coli was the most common microbiological cause - accounting for one-third of all cases. Klebsiella pneumoniae was the close second, responsible for around 30% of cases.
The patients were randomly assigned to be treated intravenously with either 2 g of cefiderocol every 8 hours or a standard-of-care antibiotic. This control course of treatment can include up to 3 antimicrobial agents which are active against gram-negative bacilli. Cefiderocol is a siderophore cephalosporin that can bind to iron in order to enter the bacterial cell. At the active site, the beta lactam chain of cefiderocol can inhibit the bacterial cell wall synthesis process, making it susceptible to lysis due to osmosis.
14 days after treatment initiation, the researchers found that the cefiderocol was equally effective to standard treatment at preventing death in patients affected with bloodstream infection. Additionally, cefiderocol was comparable with other antibiotics at clearing bacteria from the bloodstream and targeting carbapenem-resistant pathogens. The researchers noted that the mortality rate in patients treated with cefiderocol is higher than the control group if they were infected with carbapenem-resistant Acinetobacter spp.; it is not clear why this happened. Further investigation should consider coupling cefiderocol to beta-lacatamase inhibitor in order to improve its effectiveness.