Bloodstream Infection Due toa VIM-Metallo-β-Lactamase-Producing Klebsiella pneumoniae Treated with Cefiderocol in a Preterm Newborn.

Abstract

The prevalence of certain multidrug-resistant organisms (MDROs), especially Gram-negative bacteria, is dramatically increasing in patient care settings, including pediatric and neonatal units. However, most of the new drugs available for the treatment of MDROs have not yet been studied in children and newborns. We report the clinical case of a preterm neonate, born at 31weeks gestation + 1day of age by emergency Cesarean Section(CS), with a bloodstream infection (BSI) due to a Verona integron-borne metallo-β-lactamase (VIM)-producing Klebsiella pneumoniae. We successfully treated the infection with cefiderocol in an off-label regimen at the following dose: loading dose 60mg/kg and then 40mg/kg every 8h in extended infusion for 9days. The baby showed a quick clinical and biochemical improvement and tolerated wellthe treatment. Follow-up blood cultures at 48h after the start of cefiderocol were negative. Antimicrobial-resistant pathogens are of increasing concern in neonatal settings. More studies in this unique population are necessary to better describe the pharmacokinetic and pharmacodynamic profile of the new drugs against MDROs, such as cefiderocol, and to define a proper effective dose.