A case of prolonged cefiderocol therapy during continuous hemodiafiltration in a patient with an implanted left ventricular assist device.

Cefiderocol (CFDC) is a siderophore cephalosporin with activity against multidrug-resistant Gram-negative pathogens, and it is considered a treatment option for refractory Gram-negative infections. Because CFDC is primarily eliminated by the kidneys, dose individualization is required in patients with renal impairment and in those receiving renal replacement therapy. During continuous hemodiafiltration (CHDF), drug clearance is influenced not only by residual renal function but also by dialysis and filtration flow rates and membrane characteristics; thus, careful determination of dose and dosing interval is necessary. However, real-world evidence on CFDC dosing during CHDF, particularly for prolonged courses, remains limited. We report a case of refractory Pseudomonas aeruginosa bacteremia in a patient with an implanted left ventricular assist device receiving CHDF, successfully managed with a 55-day course of CFDC using a dosing strategy tailored to CHDF settings.