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Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options
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Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (31 January 2026) | Viewed by 14280

Special Issue Editor

Dr. Novella Carannante

E-Mail Website
Guest Editor
Emergency Room Infection Disease Cotugno Hospital AORN dei Colli, 80131 Naples, Italy
Interests: infectious emergency; infection control; antimicrobial stewardship
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the rapidly evolving world of infectious diseases, multidrug-resistant Gram-negative bacteria (MDR-GNB) infections present significant threats to global public health. Understanding the prognosis and outcomes of MDR-GNB infections is crucial for healthcare providers and policymakers alike.

In this Special Issue, we welcome scholars to explore current epidemiology, prognosis, and treatment options for these infections, including but not limited to those caused by Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii.

Areas of interest include:

  1. The latest advances in understanding the mechanisms of resistance and transmission dynamics, as well as novel approaches to combatting these pathogens.
  2. Evaluation of the efficacy of existing treatment options and the exploration of emerging strategies to effectively prevent and manage these infections.
  3. Addressing the need for enhanced surveillance and rapid diagnostic methods to monitor the spread of multidrug-resistant Gram-negative bacteria and support optimal clinical decision making in the optimization of treatment plans.

This Special Issue will serve as a valuable resource for clinicians, researchers, and policymakers striving to reduce the impact of drug resistance on global health.

Dr. Novella Carannante
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • multidrug-resistant gram-negative bacteria
  • epidemiology and prognosis
  • antibiotic treatment options
  • antimicrobial resistance
  • infection control and antibiotic use

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Related Special Issue

Published Papers (9 papers)

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12 pages, 542 KB  
Article
Retrospective Analysis of the Epidemiology and Risk Factors for Recurrent Biliary-Source Bloodstream Infections in Oncologic Patients
by Paola Maffezzoli, Ignacio Grafia, Mar Cusó Banús, Aina Gutiérrez-Santos, Alba Fernández, Ana Peris, Laia Llobera, Maria Dolores Quesada, Daniela Buccione, Silvia Corcione, Carolina Tudela, Carme Bracke, Anna Esquerrà, Alba Romero, Gabriela Cerdà, Rosa Benítez, Aina Mateu, Anna Sales, Alex Soriano, Roger Paredes, Pere-Joan Cardona, Francesco Giuseppe De Rosa, María Luisa Pedro-Botet and Pedro Puerta-Alcaldeadd Show full author list remove Hide full author list
Antibiotics 2026, 15(4), 342; https://doi.org/10.3390/antibiotics15040342 - 27 Mar 2026
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Abstract
Background: We aimed to describe the clinical and microbiological characteristics of biliary-source bloodstream infections (bBSIs) in patients with malignancies and identify risk factors for recurrence. Methods: All bBSI episodes in patients with active solid tumors during 2021–2025 were retrospectively reviewed. Independent [...] Read more.
Background: We aimed to describe the clinical and microbiological characteristics of biliary-source bloodstream infections (bBSIs) in patients with malignancies and identify risk factors for recurrence. Methods: All bBSI episodes in patients with active solid tumors during 2021–2025 were retrospectively reviewed. Independent risk factors for recurrent bBSI and mortality were identified. A previously published recurrence risk score was externally validated. Results: Overall, 136 patients experienced 199 bBSI episodes. Pancreatic (36.7%) and biliary tract (33.2%) were the most common cancers, and 60.8% had metastatic disease. The main pathogens were Escherichia coli (43.2%), Klebsiella pneumoniae (24.1%), and Enterococcus faecium (19.1%), and multidrug-resistant organisms accounted for 19.1%. Inappropriate empirical antibiotic treatment (IEAT) occurred in 37.2% and was independently associated with increased 30-day mortality, together with metastatic disease and septic shock. Thirty-day mortality was 24.6%. Recurrent bBSI occurred in 35.7% and was independently associated with biliary tract cancer, previous multidrug-resistant isolation, and prior hospitalization for suspected biliary infection. The externally validated recurrence score showed excellent discrimination (AUC 0.815). Conclusions: bBSI in oncology patients is associated with high rates of MDR pathogens, IEAT, recurrence, and mortality. A simple clinical score may identify patients at high risk of recurrence and guide preventive strategies. Full article
(This article belongs to the Special Issue Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options)
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12 pages, 1263 KB  
Article
Clinical Relevance of Antimicrobial Susceptibility Testing Methods in Carbapenem-Resistant Acinetobacter baumannii Pneumonia: A Secondary Analysis of a Randomized Controlled Trial
by Chutchawan Ungthammakhun, Vasin Vasikasin, Nadia Cheh-Oh, Wichai Santimaleeworagun and Dhitiwat Changpradub
Antibiotics 2026, 15(2), 189; https://doi.org/10.3390/antibiotics15020189 - 9 Feb 2026
Viewed by 881
Abstract
Background/Objective: Carbapenem-resistant Acinetobacter baumannii (CRAB) pneumonia has limited treatment options, and sulbactam MIC interpretation varies with the antimicrobial susceptibility testing (AST) method. This study compared sulbactam MICs determined using broth microdilution (BMD) and the E-test and examined their associations with 28-day mortality. [...] Read more.
Background/Objective: Carbapenem-resistant Acinetobacter baumannii (CRAB) pneumonia has limited treatment options, and sulbactam MIC interpretation varies with the antimicrobial susceptibility testing (AST) method. This study compared sulbactam MICs determined using broth microdilution (BMD) and the E-test and examined their associations with 28-day mortality. Methods: This secondary analysis used data from a randomized controlled trial comparing colistin plus sulbactam at 9 g/day versus 12 g/day in adults with CRAB pneumonia. The sulbactam MICs of 134 isolates were determined using BMD and the E-test. The agreement between methods across MIC ranges and associations between MICs, dosing, and 28-day mortality were analyzed. Results: Sulbactam MICs determined using BMD were lower than those obtained with the E-test (MIC50/90: 32/128 µg/mL vs. 96/≥256 µg/mL). Overall, agreement between methods was limited and depended on MIC level, with better agreement at lower MICs and marked discrepancies at higher MICs, where the E-test frequently overestimated the MICs. Using the IDSA breakpoint (MIC ≤ 4 µg/mL), susceptibility was identified in 6% of isolates with BMD and 3% with the E-test. A significant survival benefit with high-dose sulbactam (12 g/day) was observed in patients with BMD-determined MICs ≥ 128 µg/mL (HR 0.27; 95% CI, 0.077–0.956; p = 0.042), whereas no mortality association was seen when MICs were categorized using the E-test results. Conclusions: AST method selection substantially affects sulbactam MIC interpretation in CRAB pneumonia. BMD shows stronger correlation with clinical outcomes than the E-test, particularly at high MIC levels. High-dose sulbactam may benefit patients with highly resistant isolates, underscoring the need for accurate and standardized AST methods. Full article
(This article belongs to the Special Issue Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options)
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14 pages, 1058 KB  
Article
Clinical Outcomes of Bloodstream Infections in Liver Transplant Recipients: A Ten-Year Single-Center Retrospective Analysis, from Türkiye
by Selda Aydin, Meyha Sahin, Bahadir Ceylan, Tunahan Abali, Safa Arda Akin, Murat Dayangac and Ali Mert
Antibiotics 2026, 15(1), 90; https://doi.org/10.3390/antibiotics15010090 - 16 Jan 2026
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Abstract
Background/Objectives: Infections remain a leading cause of morbidity and mortality following liver transplantation, with bloodstream infections (BSIs) representing one of the most critical complications. This study aimed to identify factors associated with mortality in liver transplant recipients who developed BSIs over a [...] Read more.
Background/Objectives: Infections remain a leading cause of morbidity and mortality following liver transplantation, with bloodstream infections (BSIs) representing one of the most critical complications. This study aimed to identify factors associated with mortality in liver transplant recipients who developed BSIs over a 10-year period. Methods: This retrospective study was conducted at a tertiary university hospital between 1 April 2014 and 31 December 2024. A total of 467 adult patients underwent liver transplantation during the study period. Among 467 patients, a total of 210 bloodstream infection episodes occurring in 136 patients were included in the study. Results: BSIs occurred in 29.1% (136/467) of patients, with a total of 210 episodes. The median age was 55 years (IQR: 45–63). Most transplants (95.2%) were from living donors. Hepatitis B virus infection (27.1%) was the most common underlying etiology of cirrhosis. The majority of BSIs (61.2%) occurred within the first three months post-transplant. A total of 242 pathogens were isolated, with ESBL-producing Enterobacterales identified in 72.6% and carbapenem-resistant Enterobacterales (CRE) in 30.1% of cases. Notably, carbapenem resistance among Klebsiella spp. was high at 51.78%. The overall mortality rate was 14.28%. Multivariate analysis identified that a high Pitt Bacteremia Score (hazard ratio [HR] 1.502, 95% confidence interval [CI] 1.361–1.657, p < 0.001) and CRE infection (HR 3.644, 95% CI 1.380–9.620, p = 0.009) were independent predictors of mortality. Conclusions: BSIs are a significant post-transplant complication with high antimicrobial resistance. The Pitt bacteremia score is a strong predictor of mortality and may guide early risk stratification and clinical management in liver transplant recipients. Full article
(This article belongs to the Special Issue Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options)
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11 pages, 536 KB  
Article
Use of Cefiderocol for Carbapenem-Resistant Gram-Negative Infections in Hospital at Home: Multicentric Real-World Experience
by Andrea Parra-Plaza, Ainoa Ugarte, Eva Benavent, Nicole García-Poutón, Abel Mujal, María Rosa Oltra, Andrés Parra-Rojas, Verónica Rico, Manuel del Río and David Nicolás
Antibiotics 2025, 14(12), 1216; https://doi.org/10.3390/antibiotics14121216 - 3 Dec 2025
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Abstract
Background: Cefiderocol (CFD) is a novel cephalosporin targeting multidrug-resistant Gram-negative bacterial (GNB) infections. It mimics siderophores to enter into GNB through iron transport receptors. However, evidence on its use in Hospital at Home (HaH) and outpatient parenteral antibiotic therapy (OPAT) programs remains [...] Read more.
Background: Cefiderocol (CFD) is a novel cephalosporin targeting multidrug-resistant Gram-negative bacterial (GNB) infections. It mimics siderophores to enter into GNB through iron transport receptors. However, evidence on its use in Hospital at Home (HaH) and outpatient parenteral antibiotic therapy (OPAT) programs remains scarce. Objectives: The primary objective was to evaluate feasibility and efficacy of CFD in HaH setting. The secondary objective was to assess its safety. Methods: A retrospective, observational study was conducted across six Spanish centers between January 2023 and December 2024. Adult patients with documented GNB infections treated with CFD in HaH units were included. Demographic, clinical and microbiological data, treatment characteristics, and outcomes were collected. Statistical analysis was descriptive; no inferential or correlation tests were performed. Results: 27 patients were included; 70.4% were male, with a median age of 69 years. Most infections were nosocomial (65.4%), particularly skin and soft tissue (37%). Septic shock occurred in 14.8% of patients. Pseudomonas aeruginosa (66.7%) and Klebsiella pneumoniae (14.8%) were the most frequent pathogens involved, with Verona Integron-encoded metallo-B-lactamase (VIM, 50%) being the predominant resistance mechanism. CFD was used as a first-line therapy in 63% of cases and in combination with other antibiotics in 40.7%. Median treatment duration was 21.7 days. Administration was mainly via peripherally inserted central catheters (PICC, 33.3%) and electronic pumps (52%). Adverse effects occurred in 7.4% of patients, leading to discontinuation in one case. A total of 88.8% of patients achieved clinical success, with 7.7% recurrence within a month. Escalation of care occurred in 7.7% and 19.2% were readmitted within a month after HaH discharge. No infection-related deaths were reported. Conclusions: CFD is a feasible, safe, and effective treatment for difficult-to-treat GNB infections in HaH settings. Full article
(This article belongs to the Special Issue Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options)
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18 pages, 1880 KB  
Article
Antimicrobial Resistance Profiles of Clinically Relevant Enterobacteriaceae Isolates: A Retrospective Study at a Southern Italian Hospital
by Giorgia Stornelli, Beatrice Marinacci, Valentina Puca, Benedetta Pellegrini, Roberta Zita Marulli, Ivana Cataldo, Francesca Sisto, Vittoria Perrotti, Arianna Pompilio, Mattia Mori, Pamela Di Giovanni and Rossella Grande
Antibiotics 2025, 14(9), 899; https://doi.org/10.3390/antibiotics14090899 - 5 Sep 2025
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Abstract
Background: The Enterobacteriaceae family is the most heterogeneous group of Gram-negative bacilli, with both environmental and clinical relevance. Although many of these species are part of the normal intestinal microbiota, species such as Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis are [...] Read more.
Background: The Enterobacteriaceae family is the most heterogeneous group of Gram-negative bacilli, with both environmental and clinical relevance. Although many of these species are part of the normal intestinal microbiota, species such as Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis are among the most common opportunistic pathogens, frequently responsible for nosocomial infections, including urinary tract infections, bacteraemia, and pneumonia. Based on these concerns, these species are increasingly being studied for their ability to develop antimicrobial resistance, often mediated by extended spectrum β-lactamase or carbapenemase production. The present study aims to analyse the antimicrobial resistance profiles of Enterobacteriaceae isolated from a southern Italian hospital focusing on the species of major clinical importance. Methods: A retrospective analysis was carried out on biological samples collected between 2019 and 2023 at the Microbiology Laboratory of the San Pio Hospital, Vasto (Italy). Eight hundred ninety patients were included, with an average age of 73 years. Bacterial identification was carried out using bacterial culture and biochemical methods, while antimicrobial sensitivity was assessed by using the automated Walk Away System. Results: The most frequently isolated species were Escherichia coli (63.2%), Klebsiella spp. (21.9%), and Proteus spp. (8.8%). All isolates showed resistance to at least one antimicrobial and most to more than four. The highest resistance rates were observed for Cefotaxime (16.0%), followed by Ampicillin (15.6%) and Ciprofloxacin (13.2%). Conclusions: The high prevalence of antimicrobial resistance among clinically relevant Enterobacteriaceae species is a growing clinical challenge. The results of this study, which describe the trend of resistance among Enterobacteriaceae in a local hospital, could help to raise awareness highlighting the urgent need for more advanced diagnostic tools and new therapeutic strategies to treat infections caused by multi-resistant microorganisms. Full article
(This article belongs to the Special Issue Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options)
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13 pages, 717 KB  
Article
In Vitro Activity of Cefiderocol and Aztreonam/Avibactam Against Gram-Negative Non-Fermenting Bacteria: A New Strategy Against Highly Antibiotic-Resistant Infectious Agents
by Jan Závora, Václava Adámková, Alžběta Studená and Gabriela Kroneislová
Antibiotics 2025, 14(8), 762; https://doi.org/10.3390/antibiotics14080762 - 29 Jul 2025
Cited by 2 | Viewed by 2779
Abstract
Background/Objectives: Non-fermenting Gram-negative bacilli (NFGNB) represent a significant clinical challenge due to their intrinsic and acquired resistance, particularly in immunocompromised patients. Infections cause by NFGNB are associated with high morbidity and mortality, especially among patients with cystic fibrosis and hematologic malignancies. This study [...] Read more.
Background/Objectives: Non-fermenting Gram-negative bacilli (NFGNB) represent a significant clinical challenge due to their intrinsic and acquired resistance, particularly in immunocompromised patients. Infections cause by NFGNB are associated with high morbidity and mortality, especially among patients with cystic fibrosis and hematologic malignancies. This study aimed to assess the in vitro susceptibility of clinically relevant NFGNB isolates to two newer antibiotics, cefiderocol and aztreonam/avibactam, and an established antibiotic, trimethoprim/sulfamethoxazole. Methods: This retrospective, monocentric study analysed 94 NFGNB isolates (30 Pseudomonas aeruginosa, 30 Acinetobacter sp., 24 Stenotrophomonas maltophilia, and 10 Burkholderia cepacia complex). Susceptibility testing for cefiderocol, aztreonam/avibactam, and trimethoprim/sulfamethoxazole was conducted using gradient strip method. MIC values were interpreted using EUCAST breakpoints, ECOFFs, or alternative criteria when necessary. Results: All S. maltophilia isolates were susceptible to cefiderocol (FCR) and aztreonam/avibactam (A/A) based on ECOFFs, with one strain resistant to trimethoprim–sulfamethoxazole (COT). Burkholderia cepacia complex strains also showed high susceptibility to FCR, with only one isolate exceeding the ECOFF for A/A, and 20% resistant to COT. All Acinetobacter sp. isolates were susceptible to FCR; however, most MIC values clustered at or just below the ECOFF value. In P. aeruginosa, one isolate was resistant to FCR, and three isolates (10%) were resistant to A/A. Interestingly, confirmed carbapenemase producers remained susceptible to both FCR and A/A. Most A/A MIC values for P. aeruginosa were just below the ECOFF. Conclusions: Cefiderocol and aztreonam/avibactam demonstrated promising in vitro activity against clinically relevant NFGNB, including carbapenem-resistant strains. These findings support their potential role as therapeutic options for difficult-to-treat infections, particularly in immunocompromised patients. Full article
(This article belongs to the Special Issue Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options)
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13 pages, 1371 KB  
Article
Multisite Infections Caused by Carbapenem-Resistant Klebsiella Pneumoniae: Unveiling the Clinical Characteristics and Risk Factors
by Jing Li, Shunjun Wu, Huanhuan Zhang, Xingxing Guo, Wanting Meng, Heng Zhao and Liqiang Song
Antibiotics 2025, 14(7), 721; https://doi.org/10.3390/antibiotics14070721 - 18 Jul 2025
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Abstract
Objectives: There is a scarcity of studies on multisite infections (MSIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). The primary objectives of this research were to determine the clinical characteristics of CRKP MSI, and the risk factors of infection and mortality. Methods: [...] Read more.
Objectives: There is a scarcity of studies on multisite infections (MSIs) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). The primary objectives of this research were to determine the clinical characteristics of CRKP MSI, and the risk factors of infection and mortality. Methods: Patients with a CRKP bloodstream infection (BSI) were enrolled retrospectively between January 2017 and December 2021 in Xijing Hospital, China. The risk factors for CRKP MSI and mortality were evaluated. The demographic data, clinical and microbiological characteristics, therapy and outcomes were analyzed. Results: Among 101 patients, 74.3% (75/101) had a diagnosis of CRKP MSI, while 25.7% (26/101) of CRKP non-MSI. The overall case fatality rate was 42.6% (43/101). Multivariate analysis indicated that previous surgery (OR 3.971, 95% CI 1.504–10.480, p = 0.005) and ICU admission (OR 3.322, 95% CI 1.252–8.816, p = 0.016) were independent risk factors for CRKP MSI. ICU admission (OR 4.765, 95% CI 1.192–19.054, p = 0.027), a Pitt bacteremia score (PBS) > 4 (OR 3.820, 95% CI 1.218–11.983, p = 0.022) and thrombocytopenia (OR 8.650, 95% CI 2.573–29.007, p < 0.001) were independent risk factors for mortality due to CRKP MSI. Conclusions: Our findings confirmed that CRKP MSIs were associated with poorer outcomes. To improve prognosis, early screening of individuals at the highest risk is vital. Full article
(This article belongs to the Special Issue Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options)
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11 pages, 491 KB  
Article
Ciprofloxacin for the Treatment of Infections Caused by Carbapenemase-Producing Gram-Negative Bacteria
by Pablo Rubiñan, Belén Viñado, Nuria Fernández-Hidalgo, Nieves Larrosa, Abiu Sempere, David Campany, Dolors Rodríguez-Pardo, Juan José González-López, Xavier Nuvials, Ester del Barrio-Tofiño, Laura Escolà-Vergé and Ibai Los-Arcos
Antibiotics 2024, 13(12), 1138; https://doi.org/10.3390/antibiotics13121138 - 26 Nov 2024
Cited by 1 | Viewed by 3657
Abstract
Background: There is no experience with ciprofloxacin for the treatment of carbapenemase-producing Gram-negative bacteria (CP-GNB) infections. Methods: This is a retrospective single-centre study where we describe the clinical evolution of all consecutive adult patients who received ciprofloxacin monotherapy for the treatment of CP-GNB [...] Read more.
Background: There is no experience with ciprofloxacin for the treatment of carbapenemase-producing Gram-negative bacteria (CP-GNB) infections. Methods: This is a retrospective single-centre study where we describe the clinical evolution of all consecutive adult patients who received ciprofloxacin monotherapy for the treatment of CP-GNB infections. Primary outcomes were clinical failure (defined as death, lack of clinical improvement or a switch to another drug) at day 14 and 30-day all-cause mortality. Results: Nineteen patients were included. Fifteen (79%) were men, the median age was 74 years (IQR 66–79) and the median Charlson comorbidity index was five (IQR 3–6.5). The most frequent infections were: nine complicated urinary tract infections, three soft tissue infections and three intra-abdominal infections. Twenty CP-GNBs were isolated (one patient had a coinfection): nine VIM-type-producing Enterobacterales, nine OXA-48-type-producing Enterobacterales and two VIM-type-producing Pseudomonas aeruginosa. Six (32%) patients had positive blood cultures, and one presented with septic shock. The median duration of ciprofloxacin treatment was 14 days (IQR 10–15). One patient presented with clinical failure at day 14. There was no 30-day mortality. Two patients exhibited microbiological recurrence at day 90. There were no reported adverse effects. Conclusions: Monotherapy with ciprofloxacin may be an alternative treatment for selected, clinically stable patients with ciprofloxacin-susceptible CP-GNB infections. Full article
(This article belongs to the Special Issue Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options)
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7 pages, 219 KB  
Case Report
Hemodialysis Central Venous Catheter-Associated Bloodstream Infection Caused by Stenotrophomonas maltophilia Treated with Cefiderocol and Levofloxacin After Failure of Trimethoprim–Sulfamethoxazole Monotherapy and Device Replacement
by Simone Meini, Alberto Antonelli, Benedetta Longo, Maddalena Mura, Elisabetta Andreoli, Angeliki Kanaki, Giulia Grassi, Claudia Niccolai, Bruno Viaggi and Gian Maria Rossolini
Antibiotics 2026, 15(3), 265; https://doi.org/10.3390/antibiotics15030265 - 4 Mar 2026
Viewed by 493
Abstract
Background: Stenotrophomonas maltophilia infections represent a clinical challenge in treating frail and immunocompromised patients. Alternatives to trimethoprim–sulfamethoxazole (SXT) are needed, with cefiderocol (FDC) representing a promising option, but clinical evidence is limited; moreover, data to support the superiority of mono or combination [...] Read more.
Background: Stenotrophomonas maltophilia infections represent a clinical challenge in treating frail and immunocompromised patients. Alternatives to trimethoprim–sulfamethoxazole (SXT) are needed, with cefiderocol (FDC) representing a promising option, but clinical evidence is limited; moreover, data to support the superiority of mono or combination therapy are lacking. Case presentation: We describe the case of a 55-year-old female patient with a tunneled hemodialysis central venous catheter (HD-CVC)-associated bloodstream infection caused by S. maltophilia that, after failure of a prolonged SXT monotherapy, was successfully treated by HD-CVC replacement followed by intravenous cefiderocol (FDC) and levofloxacin (LVX). Conclusions: FDC represents an interesting option for complex cases of S. maltophilia bloodstream infections, and the combination with LVX might add benefit in cases associated with biofilm formation on intravascular devices. Full article
(This article belongs to the Special Issue Multidrug-Resistant Gram-Negative Bacteria Infections: Current Epidemiology, Prognosis and Treatment Options)
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