Cefiderocol is a novel synthetic
siderophore-conjugated
antibiotic that hijacks the bacterial
iron transport systems facilitating
drug entry into cells, achieving high periplasmic concentrations. This systematic review analyzed the currently available literature on
cefiderocol. It summarized in vitro susceptibility data, in vivo antimicrobial activity, pharmacokinetics/pharmacodynamics (PK/PD), clinical efficacy, safety and resistance mechanisms of
cefiderocol.
Cefiderocol has potent in vitro and in vivo activity against multidrug-resistant (MDR) Gram-negative bacteria, including
carbapenem-resistant isolates. But New Delhi Metallo-β-lactamase (NDM)- positive isolates showed significantly higher MICs than other
carbapenemase-producing Enterobacterales, with a susceptible rate of 83.4% for
cefiderocol.
Cefiderocol is well-tolerated, and the PK/PD target values can be achieved using a standard dose regimen or adjusted doses according to renal function. Clinical trials demonstrated that
cefiderocol was non-inferiority to the comparator drugs in treating complicated
urinary tract infection and
nosocomial pneumonia. Case reports and series showed that
cefiderocol was a promising therapeutic agent in
carbapenem-resistant
infections. However, resistant isolates and reduced susceptibility during treatment to
cefiderocol have already been reported. In conclusion,
cefiderocol is a promising powerful weapon for treating MDR recalcitrant
infections.