Cefiderocol as Adjunctive Treatment of Necrotizing Ventilator-associated Pneumonia Due to Extensively Drug-Resistant Pseudomonas aeruginosa

There are few treatment options for patients with extensively drug-resistant gram-negative infections. Cefiderocol is a novel beta-lactam with excellent in vitro activity against multidrug-resistant gram-negative isolates, including carbapenem-resistant strains. However, this drug performed poorly versus best available therapy in an open-label randomized study of carbapenem-resistant gram-negative infections. Here, we present a case of a 32-year-old man with necrotizing ventilator-associated pneumonia caused by Pseudomonas aeruginosa who developed resistance to meropenem and ceftolozane/tazobactam while on therapy. Addition of expanded-access cefiderocol to his antimicrobial regimen contributed to successful microbiological cure while limiting exposure to nephrotoxic therapeutic agents.