Utilization of Cefiderocol in a Case of Extensively Drug-Resistant Klebsiella pneumoniae Prostatitis and Recurrent Urinary Tract Infection.

Treatment of extensively drug-resistant (XDR) organisms is complicated by pharmacodynamic and pharmacokinetic (PK) limitations of current antimicrobial agents. Prostatitis is an infection that is historically difficult to treat with beta-lactams given poor tissue penetration as compared to fluoroquinolones and sulfamethoxazole-trimethoprim. Cefiderocol is a novel cephalosporin that is often used to treat a wide variety of gram-negative bacteria that have extensive resistance to other antibiotics. Cefiderocol remains stable against many β-lactamases and shows enhanced bacterial cell entry as a result of siderophore uptake. However, its penetration into prostatic tissue has not been studied. This review presents the use of cefiderocol in a patient with complicated urinary tract infection and prostatitis caused by XDR Klebsiella pneumoniae resistant to almost all tested antibiotics, including novel beta-lactam/beta-lactamase combinations. Although PK data suggest that cefiderocol may achieve therapeutic concentrations in prostatic tissue, further studies are needed to confirm its efficacy in treating prostatitis, particularly in cases of chronic or complicated infection. This case highlights cefiderocol as a potential therapeutic option for XDR Enterobacterales prostatitis, though additional research is required to fully understand its prostate penetration and clinical outcomes.