Salvage Treatment with Cefiderocol Regimens in Two Intravascular Foreign Body Infections by MDR Gram-Negative Pathogens, Involving Non-Removable Devices.

Introduction: The objective of this study was to describe two challenging cases of intravascular foreign body infections caused by multidrug-resistant Gram-negative pathogens requiring complex antimicrobial regimens including cefiderocol and successfully treated without implant removal.

Methods: Clinical charts and microbiological reports of the clinical cases.

Results: Case 1 included a left ventricular assist device (HEARTMATE 3™Abbot) infection due to Achromobacter xylosoxidans, while case 2 included a portal prosthesis infection due to Pseudomonas aeruginosa. As the pathogens were multidrug-resistant (MDR), both cases required antimicrobial regimens with cefiderocol; treatment was successful without implant removal. Importantly, case 1 presented a probable, drug-induced thrombocytopenia, a non-previously described side effect related to cefiderocol.

Conclusion: Cefiderocol may be an additional, promising drug to the available arsenal, even for challenging foreign body infections caused by MDR Gram-negative pathogens.