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BACKGROUND: Multidrug-resistant Stenotrophomonas maltophilia (MDR Sm) is an emerging neonatal pathogen with limited therapeutic options. Cefiderocol shows potent in vitro activity, but neonatal clinical data are scarce. CASE PRESENTATION: We report an extremely preterm male infant (27 + 2 weeks, 800 g) who developed ventilator-associated pneumonia due to a metallo-β-lactamase-producing MDR Sm on day 50 of life. MANAGEMENT AND OUTCOMES: Targeted therapy with cefiderocol (100 mg/kg q8h) plus trimethoprim-sulfamethoxazole (7 mg/kg q8h) led to extubation within 24 hours, C-reactive protein normalization within 72 hours, and radiographic clearance by day 14. No adverse events occurred. The infant was discharged on room air and remained well at 6-month follow-up. CONCLUSIONS: Cefiderocol may represent a safe and effective salvage option for MDR Sm ventilator-associated pneumonia in extremely preterm neonates, but further pharmacokinetic, pharmacodynamic and stewardship studies are needed.
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Scavone et al. (2025) studied this question.
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