Treatment of post-lung transplantation pneumonia with cefiderocol: a case series and insights from the literature

Background: Post-lung transplantation pneumonia (pLuTP) is among the most frequent complications following lung transplantation, predominantly caused by Gram-negative bacteria (GNB). The emergence of multidrug-resistant (MDR) non-fermenting GNB as aetiological agents of pLuTP represents a major therapeutic challenge due to limited treatment options. Methods: We present a retrospective case series describing 20 episodes of pLuTP successfully treated with cefiderocol. Results: Thirteen patients, with a median age of 56 years (IQR 44–59), experienced a total of 20 episodes of pLuTP. In 3 cases (25.0%), polymicrobial pneumonia was diagnosed. Acinetobacter baumannii was isolated in 13/20 episodes (65.0%), followed by Pseudomonas aeruginosa (6/20, 30.0%), Achromobacter xylosoxidans and Klebsiella pneumoniae (2/20, 10.0% each). Cefiderocol was administered in all episodes: as monotherapy in 5/20 cases (25.0%), in combination with high-dose ampicillin/sulbactam in 7/20 cases (35.0%), aminoglycosides or intravenous colistin (2/20, 10.0% each), and other regimens in the remaining 4/20 cases (20.0%). Clinical cure was achieved in 17/20 cases (85.0%). Microbiological eradication was not achieved in any case. Relapse occurred in 4/20 episodes (20.0%), with no evidence of in vitro cefiderocol resistance. No major adverse events were reported. Conclusions: Cefiderocol may represent a valuable therapeutic option for managing pLuTP caused by difficult-to-treat GNB in lung transplant recipients.