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Real-World Evidence: cefiderocol therapeutic drug monitoring in critically ill, obese patients in NDM infections
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  • Giorgia Menegatti,
  • ALESSANDRA MANCA,
  • Jessica Cusato,
  • Cecilia Grosso,
  • Silvia Corcione,
  • Chiara Risso,
  • giorgia montrucchio,
  • silvia scabini,
  • Amedeo De Nicolò,
  • francesco giuseppe de rosa,
  • Antonio D'Avolio
Giorgia Menegatti
University of Turin

Corresponding Author:giorgia.menegatti@unito.it

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ALESSANDRA MANCA
Laboratory of Clinical Pharmacology and Pharmacogenetics, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, Corso Svizzera, 164, 10149 Turin, Italy
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Jessica Cusato
University of Turin
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Cecilia Grosso
University of Turin
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Silvia Corcione
University of Turin
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Chiara Risso
University of Turin
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giorgia montrucchio
university of turin, department of anesthesia and critical care
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silvia scabini
University of Turin
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Amedeo De Nicolò
University of Turin
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francesco giuseppe de rosa
University of Turin
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Antonio D'Avolio
Pharmacokinetics and Pharmacogenetics Laboratory, University of Torino
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Abstract

Background and Purpose: Cefiderocol (FDC) application on critically ill patients is still limited: recommended dosing regimens are usually derived from studies on healthy subjects, but critical illness is always associated with physio/pathological alterations in patients, resulting in drug concentration perturbation. Furthermore, there is a scant real-life data addressing particular sub-populations, like morbidly/obese and augmented renal clearance patients, making pharmacokinetics/pharmacodynamics (PK/PD) target recommendation debated. The aim of this study was to present FDC PK/PD values in patients from morbidly to pathologically obese and with augmented renal clearance. Experimental Approach: Ten patients with K. pneumoniae NDM infections were enrolled. Plasma therapeutic drug monitoring was performed after steady-state at different timings. The conventional PK/PD target of fT>MIC has been considered, along with a more aggressive target of fT>6 x MIC; evaluated clinical outcomes were microbiological eradication and 30 days mortality. Key Results: A correlation between weight and 30 days mortality was highlighted. The percentage of failure in achieving the microbiological eradication progressively increased with higher BMI. Furthermore, 100% patients reached the conventional PK/PD target of fCmin>4 mg/L; while, when evaluating a more aggressive target of 100% fT>6 x MIC (2 mg/L), different factors showed an influence as FDC minimum free concentration, area under the concentration time curve and drug clearance. Conclusion and Implications: Our study may be useful in real-world evidence, highlighting the important influence of BMI and high value of clearance in achieving the microbiological target, suggesting that further study and the use of therapeutic drug monitoring in this context are needed.