Bacterial Pneumonia
Conditions
Brief summary
The primary purpose of the study is to determine the degree of penetration of cefiderocol into infected lung tissue in hospitalized adults with bacterial pneumonia who are being mechanically ventilated.
Interventions
DRUGCefiderocol
Administered intravenously, at a dosage determined based on renal function.
DRUGStandard of Care Antibiotic
Standard of care antibiotic treatment for pneumonia
Sponsors
Shionogi
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Subject is 18 years or older at the time written informed consent is obtained 2. Subject has provided written informed consent or informed consent has been provided by subject's legally authorized representative 3. Subject has a diagnosis or suspicion of bacterial pneumonia (even if later known that the subject does not have bacterial pneumonia, discontinuation of the study is not necessary) 4. Subject is hospitalized and receiving standard of care antibiotic treatment for pneumonia 5. Subject is mechanically ventilated or expected to be mechanically ventilated at least 48 hours (or 72 hours for subjects with severe renal impairment) after the first dose of cefiderocol 6. Subject has a life expectancy of at least 3 weeks from the Screening visit 7. Subject is male (no contraception required) or female and meets 1 of the following criteria: 1. Surgically sterile (has had a hysterectomy and/or bilateral oophorectomy, or a bilateral salpingectomy or tubal ligation for the purpose of contraception for at least 6 weeks with appropriate documentation of such surgery) 2. Postmenopausal (defined as older than 45 years of age with cessation of regular menstrual periods for at least 6 months and a follicle-stimulating hormone level of \> 40 mIU/mL, or amenorrhea for at least 12 months) 3. Of childbearing potential and using combined (estrogen and progestogen) or progestogen-only hormonal contraception associated with inhibition of ovulation (including oral, intravaginal, injectable, implantable, and transdermal contraceptives), or an intrauterine device (IUD), or intrauterine hormone-releasing system for the entire duration of the study 4. Of childbearing potential and practicing abstinence as a preferred and usual life style and/or agrees to continue practicing abstinence from Screening for the entire duration of the study 5. Of childbearing potential and whose sole heterosexual partner has been successfully vasectomized and agrees to not have other heterosexual partners for the entire duration of the study
Exclusion criteria
Subjects who meet any of the following criteria will be excluded from the study: 1. Subject has a chemical pneumonia that does not require antibiotic treatment (including aspiration of gastric acid, inhalation injury). The term chemical pneumonia refers to the aspiration of substances that are toxic to the lower airways causing chemical burn and injuries in the airway. 2. Subject has a history of any moderate or severe hypersensitivity or allergic reaction to any β-lactam (Note: for β-lactams, a history of a mild rash followed by uneventful re-exposure is not a contraindication to enrollment) 3. Subject has extensive cystic lesion(s) or severe structural abnormality (eg, cystic fibrosis, emphysema, cystic lesions of sarcoidosis or tuberculosis, postobstructive pneumonia due to lung cancer, etc) of the lung that hinders recovery of bronchoalveolar lavage fluid (BALF) 4. Subject is receiving peritoneal dialysis 5. Subject has severe renal impairment requiring hemodialysis (HD) or end-stage renal disease requiring HD 6. Subject is in refractory septic shock defined as persistent hypotension despite adequate fluid resuscitation or despite vasopressive therapy at Screening 7. Subject is a female who has a positive pregnancy test at Screening or who is lactating 8. Subject has received another investigational drug within 30 days prior to Screening 9. Subject has previously participated in this clinical study and has received at least 1 dose of cefiderocol within 7 days 10. Subject has any condition or circumstance that, in the opinion of the investigator, would compromise the safety of the subject or the quality of the study data
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Concentration of Cefiderocol in Epithelial Lining Fluid | At the third dosing (or sixth dosing for participants with severe renal impairment; 16 or 40 hours after first dose, respectively), at 3 hours after the start of the infusion or 2 hours after the end of infusion. | Samples for determination of cefiderocol concentrations in the epithelial lining fluid (ELF) were collected by bronchoalveolar lavage (BAL) procedure on the inflamed section of the lung (ie, a lobe where pneumonia was expected to be present based on chest radiologic imaging) after multiple doses of cefiderocol sufficient to approximate steady state concentrations in blood. The ELF sample for the determination of cefiderocol concentrations was collected at 3 hours after the start of administration of cefiderocol for the first 4 enrolled participants and at 2 hours after the end of infusion for the following 3 participants. Cefiderocol concentrations were determined using liquid chromatography/tandem mass spectrometry (LC/MS/MS), with a lower limit of quantification of cefiderocol in ELF of 0.005 μg/mL. Cefiderocol concentrations in ELF were calculated using cefiderocol concentrations in BAL, adjusted by the ratio of urea concentrations in blood and BAL. |
| Ratio of the Concentration of Cefiderocol in Epithelial Lining Fluid Relative to Plasma | At the third dosing (or sixth dosing for participants with severe renal impairment; 16 or 40 hours after start of the first dose, respectively), at 3 hours after the start of the infusion or 2 hours after the end of infusion. | The concentration of cefiderocol in ELF to plasma ratio (RC,E/P) represents the penetration of cefiderocol into infected lung tissue. ELF and plasma cefiderocol concentrations were determined using liquid chromatography/tandem mass spectrometry (LC/MS/MS). The lower limit of quantification of cefiderocol in plasma and ELF was 0.1 μg/mL and 0.005 μg/mL, respectively. |
Countries
United States
Participant flow
Recruitment details
This study was conducted at 3 sites in the United States. Seven adults with known or suspected bacterial pneumonia being treated with standard of care (SOC) antibiotics and requiring mechanical ventilation were enrolled.
Participants by arm
| Arm | Count |
|---|---|
| Cefiderocol Participants received 2 g cefiderocol (or renally adjusted doses) every 8 hours (or every 6 hours for participants with augmented renal function), administered by intravenous infusion over 3 hours for a total of 3 to 6 doses. | 7 |
| Total | 7 |
Baseline characteristics
| Characteristic | Cefiderocol |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 4 Participants |
| Age, Categorical Between 18 and 65 years | 3 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 5 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 1 Participants |
| Race/Ethnicity, Customized Black or African American | 1 Participants |
| Race/Ethnicity, Customized Other | 1 Participants |
| Race/Ethnicity, Customized White | 5 Participants |
| Sex: Female, Male Female | 4 Participants |
| Sex: Female, Male Male | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 7 |
| other Total, other adverse events | 7 / 7 |
| serious Total, serious adverse events | 0 / 7 |
Outcome results
Primary
Concentration of Cefiderocol in Epithelial Lining Fluid
Samples for determination of cefiderocol concentrations in the epithelial lining fluid (ELF) were collected by bronchoalveolar lavage (BAL) procedure on the inflamed section of the lung (ie, a lobe where pneumonia was expected to be present based on chest radiologic imaging) after multiple doses of cefiderocol sufficient to approximate steady state concentrations in blood. The ELF sample for the determination of cefiderocol concentrations was collected at 3 hours after the start of administration of cefiderocol for the first 4 enrolled participants and at 2 hours after the end of infusion for the following 3 participants. Cefiderocol concentrations were determined using liquid chromatography/tandem mass spectrometry (LC/MS/MS), with a lower limit of quantification of cefiderocol in ELF of 0.005 μg/mL. Cefiderocol concentrations in ELF were calculated using cefiderocol concentrations in BAL, adjusted by the ratio of urea concentrations in blood and BAL.
Time frame: At the third dosing (or sixth dosing for participants with severe renal impairment; 16 or 40 hours after first dose, respectively), at 3 hours after the start of the infusion or 2 hours after the end of infusion.
Population: All participants who received at least 1 dose of cefiderocol and who had at least 1 evaluable concentration of cefiderocol in bronchoalveolar lavage fluid.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) |
|---|---|---|---|
| Cefiderocol | Concentration of Cefiderocol in Epithelial Lining Fluid | 3 hours after start of infusion | 7.63 μg/mL |
| Cefiderocol | Concentration of Cefiderocol in Epithelial Lining Fluid | 2 hours after end of infusion | 10.4 μg/mL |
Primary
Ratio of the Concentration of Cefiderocol in Epithelial Lining Fluid Relative to Plasma
The concentration of cefiderocol in ELF to plasma ratio (RC,E/P) represents the penetration of cefiderocol into infected lung tissue. ELF and plasma cefiderocol concentrations were determined using liquid chromatography/tandem mass spectrometry (LC/MS/MS). The lower limit of quantification of cefiderocol in plasma and ELF was 0.1 μg/mL and 0.005 μg/mL, respectively.
Time frame: At the third dosing (or sixth dosing for participants with severe renal impairment; 16 or 40 hours after start of the first dose, respectively), at 3 hours after the start of the infusion or 2 hours after the end of infusion.
Population: All participants who received at least 1 dose of cefiderocol and who had at least 1 evaluable concentration of cefiderocol in bronchoalveolar lavage fluid. Cefiderocol concentration was measured 3 hours after the start of the infusion in the first 4 enrolled participants and 2 hours after the end of infusion in the following 3 participants.
| Arm | Measure | Group | Value (GEOMETRIC_MEAN) |
|---|---|---|---|
| Cefiderocol | Ratio of the Concentration of Cefiderocol in Epithelial Lining Fluid Relative to Plasma | 3 hours after start of infusion | 0.0893 ratio |
| Cefiderocol | Ratio of the Concentration of Cefiderocol in Epithelial Lining Fluid Relative to Plasma | 2 hours after end of infusion | 0.231 ratio |