Cefiderocol in Combination With Trimethoprim-sulfamethoxazole for Multidrug-resistant Stenotrophomonas maltophilia Ventilator-associated Pneumonia in an Extremely Preterm Infant: A Case Report.

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.