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. 2020 Dec 17;71(10):2713-2716.
doi: 10.1093/cid/ciaa355.

Clinical Evolution of AmpC-Mediated Ceftazidime-Avibactam and Cefiderocol Resistance in Enterobacter cloacae Complex Following Exposure to Cefepime

Ryan K Shields  1   2 , Alina Iovleva  1 , Ellen G Kline  1 , Akito Kawai  3   4 , Christi L McElheny  1 , Yohei Doi  1   2   3   4
Affiliations

Clinical Evolution of AmpC-Mediated Ceftazidime-Avibactam and Cefiderocol Resistance in Enterobacter cloacae Complex Following Exposure to Cefepime

Ryan K Shields et al. Clin Infect Dis. .

Abstract

We report 2 independent patients from whom carbapenem and ceftazidime-avibactam-resistant Enterobacter cloacae complex strains were identified. The ceftazidime-avibactam resistance was attributed to a 2-amino acid deletion in the R2 loop of AmpC β-lactamase, which concurrently caused resistance to cefepime and reduced susceptibility to cefiderocol, a novel siderophore cephalosporin.

Keywords: R2 loop; cefepime; deletion; β-lactamase.

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Figures

Figure 1.
Figure 1.
A, Modeled structure of AmpC of Enterobacter hormaechei Ent630. AmpC of Enterobacter cloacae P99 is shown in orange, upon which the structure of AmpC of Ent630 is imposed in magenta. Bound ceftazidime is shown in purple. B–D, Enlarged view of the area containing A292_L293del. Molecular surfaces are shown in magenta (AmpC of Ent630, C) and orange (AmpC of P99, D), and L293 in AmpC of P99 is shown in orange sticks.
See this image and copyright information in PMC

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