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. 2020 Nov 17;64(12):e01582-20.
doi: 10.1128/AAC.01582-20. Print 2020 Nov 17.

In Vitro Activity of Cefiderocol, a Siderophore Cephalosporin, against Multidrug-Resistant Gram-Negative Bacteria

Shazad Mushtaq  1 , Zahra Sadouki  2 , Anna Vickers  2 , David M Livermore  3 , Neil Woodford  2
Affiliations

In Vitro Activity of Cefiderocol, a Siderophore Cephalosporin, against Multidrug-Resistant Gram-Negative Bacteria

Shazad Mushtaq et al. Antimicrob Agents Chemother. .

Abstract

Cefiderocol is a parenteral siderophore cephalosporin with a catechol-containing 3' substituent. We evaluated its MICs against Gram-negative bacteria, using iron-depleted Mueller-Hinton broth. The panel comprised 305 isolates of Enterobacterales, 111 of Pseudomonas aeruginosa, and 99 of Acinetobacter baumannii, all selected for carbapenem resistance and multidrug resistance to other agents. At 2 and 4 μg/ml, cefiderocol inhibited 78.7 and 92.1%, respectively, of all Enterobacterales isolates tested, with rates of 80 to 100% for isolates with all modes of carbapenem resistance except NDM enzymes (41.0% inhibited at 2 μg/ml and 72.1% at 4 μg/ml) or combinations of extended-spectrum β-lactamase (ESBL) and porin loss (61.5% inhibited at 2 μg/ml and 88.5% at 4 μg/ml). Cefiderocol also inhibited 81.1 and 86.5% of all P. aeruginosa isolates at 2 and 4 μg/ml, respectively, with rates of 80 to 100% for isolates with VIM, IMP, GES, or VEB β-lactamases and slightly lower rates for those with NDM (45.5% at 2 μg/ml and 72.7% at 4 μg/ml) and PER (66.7% at 2 μg/ml and 73.3% at 4 μg/ml) enzymes; 63.3% of P. aeruginosa isolates were inhibited at the FDA's 1-μg/ml breakpoint. Lastly, cefiderocol at 2 and 4 μg/ml inhibited 80.8 and 88.9% of the A. baumannii isolates, respectively, with rates of >85% for isolates with OXA-51-like, -23, -24, or -58 enzymes and 50% at 2 μg/ml and 80% at 4 μg/ml for those with NDM carbapenemases. Dipicolinic acid and avibactam weakly potentiated cefiderocol against Enterobacterales isolates with metallo-β-lactamases (MBLs) and serine carbapenemase, respectively, indicating incomplete β-lactamase stability.

Keywords: Acinetobacter baumannii; Enterobacterales; Enterobacteriaceae; NDM; Pseudomonas aeruginosa; antimicrobial activity; antimicrobial resistance; carbapenamase; cefiderocol; multidrug resistance.

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Figures

FIG 1
FIG 1
Cefiderocol MIC distribution, by species, for Enterobacterales isolates (n = 305). An asterisk indicates that the data for Enterobacter include 8 isolates of Klebsiella aerogenes (formerly Enterobacter aerogenes) and 1 isolate of Pluralibacter gergoviae (formerly Enterobacter gergoviae).
See this image and copyright information in PMC

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