Abstract Background Bacterial ventriculitis associated with CSF shunts or drains is a life-threatening infection often caused by MDR pathogens such as Stenotrophomonas maltophilia. Cefiderocol, an IV siderophore cephalosporin approved for drug-resistant Gram-negative infections, lacks extensive clinical data supporting its use in CNS infections. Objectives We describe a case of S. maltophilia ventriculitis successfully treated with cefiderocol monotherapy at a standard dose of 2 g IV every 8 h. Data on cefiderocol CSF drug penetration are reported. Methods Cefiderocol trough plasma and CSF concentrations (Cmin) were determined at steady-state conditions, and S. maltophilia susceptibility testing was determined using Etest and disc diffusion. Results Therapeutic drug monitoring showed sustained CSF cefiderocol concentrations. CSF cefiderocol Cmin remained 116.0- and 131.8-fold above the isolate’s MIC throughout the dosing interval, with plasma-to-CSF penetration ratios of 16.6%–25.7%. Patient’s clinical cure was achieved after 26 days of therapy without adverse events or relapse at 1 year of follow-up. Conclusions Our data show that cefiderocol at a standard dose of 2 g IV every 8 h achieved sustained therapeutic concentrations in the CSF. Cefiderocol monotherapy may be an option for CNS infections with MDR Gram-negative bacteria with low MICs such as S. maltophilia.
Ribera et al. (Thu,) studied this question.