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Karakonstantis S, Rousaki M, Vassilopoulou L, Kritsotakis EI. Global prevalence of cefiderocol non-susceptibility in Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia: a systematic review and meta-analysis. Clin Microbiol Infect 2024; 30:178-188. [PMID: 37666449 DOI: 10.1016/j.cmi.2023.08.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/14/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Cefiderocol is a last resort option for carbapenem-resistant (CR) Gram-negative bacteria, especially metallo-β-lactamase-producing Pseudomonas aeruginosa and CR Acinetobacter baumannii. Monitoring global levels of cefiderocol non-susceptibility (CFDC-NS) is important. OBJECTIVES To systematically collate and examine studies investigating in vitro CFDC-NS and estimate the global prevalence of CFDC-NS against major Gram-negative pathogens. DATA SOURCES PubMed and Scopus, up to May 2023. STUDY ELIGIBILITY CRITERIA Eligible were studies reporting CFDC-NS in Enterobacterales, P. aeruginosa, A. baumannii, or Stenotrophomonas maltophilia clinical isolates. RISK-OF-BIAS ASSESSMENT Two independent reviewers extracted study data and assessed the risk of bias on the population, setting, and measurement (susceptibility testing) domains. DATA SYNTHESIS Binomial-Normal mixed-effects models were applied to estimate CFDC-NS prevalence by species, coresistance phenotype, and breakpoint definition (EUCAST, CLSI, and FDA). Sources of heterogeneity were investigated by subgroup and meta-regression analyses. RESULTS In all, 78 studies reporting 82 035 clinical isolates were analysed (87% published between 2020 and 2023). CFDC-NS prevalence (EUCAST breakpoints) was low overall but varied by species (S. maltophilia 0.4% [95% CI 0.2-0.7%], Enterobacterales 3.0% [95% CI 1.5-6.0%], P. aeruginosa 1.4% [95% CI 0.5-4.0%]) and was highest for A. baumannii (8.8%, 95% CI 4.9-15.2%). CFDC-NS was much higher in CR Enterobacterales (12.4%, 95% CI 7.3-20.0%) and CR A. baumannii (13.2%, 95% CI 7.8-21.5%), but relatively low for CR P. aeruginosa (3.5%, 95% CI 1.6-7.8%). CFDC-NS was exceedingly high in New Delhi metallo-β-lactamase-producing Enterobacterales (38.8%, 95% CI 22.6-58.0%), New Delhi metallo-β-lactamase-producing A. baumannii (44.7%, 95% CI 34.5-55.4%), and ceftazidime/avibactam-resistant Enterobacterales (36.6%, 95% CI 22.7-53.1%). CFDC-NS varied considerably with breakpoint definition, predominantly among CR bacteria. Additional sources of heterogeneity were single-centre investigations and geographical regions. CONCLUSIONS CFDC-NS prevalence is low overall, but alarmingly high for specific CR phenotypes circulating in some institutions or regions. Continuous surveillance and updating of global CFDC-NS estimates are imperative while cefiderocol is increasingly introduced into clinical practice. The need to harmonize EUCAST and CLSI breakpoints was evident.
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Affiliation(s)
- Stamatis Karakonstantis
- Internal Medicine Department, Infectious Diseases Division, University Hospital of Heraklion, Crete, Greece
| | - Maria Rousaki
- Master of Public Health Program, Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Loukia Vassilopoulou
- 2nd Department of Internal Medicine, Venizeleio-Pananeio General Hospital, Heraklion, Crete, Greece
| | - Evangelos I Kritsotakis
- Laboratory of Biostatistics, Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece; School of Health and Related Research, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK.
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Ibrahim A, Bouvier M, Sadek M, Decousser JW, Poirel L, Nordmann P. A Selective Culture Medium for Screening Cefiderocol Resistance in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii. J Clin Microbiol 2023; 61:e0188322. [PMID: 37338403 PMCID: PMC10358180 DOI: 10.1128/jcm.01883-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/29/2023] [Indexed: 06/21/2023] Open
Abstract
Cefiderocol (FDC) is a siderophore cephalosporin with a broad spectrum of activity against many multidrug-resistant Gram-negative bacteria. Acquired resistance to FDC has been already reported among Gram-negative isolates, thus highlighting the need for rapid and accurate identification of such resistant pathogens, in order to control their spread. Therefore, the SuperFDC medium was developed to screen FDC-resistant Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii. After testing several culture conditions, a selective medium was set up by supplementing an iron-depleted agar medium with 8 μg/mL of FDC and evaluated with a collection of 68 FDC-susceptible and 33 FDC-resistant Gram-negative isolates exhibiting a variety of β-lactam resistance mechanisms. The sensitivity and specificity of detection of this medium were evaluated at 97% and 100%, respectively. In comparison with the reference broth microdilution method, only 3% very major errors were found. In addition, excellent detection performances were obtained by testing spiked stools with a lower limit of detection ranging between 100 and 103 CFU/mL. The SuperFDC medium allows detection of FDC-resistant Gram-negative isolates regardless of their corresponding resistance mechanisms.
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Affiliation(s)
- Ahmad Ibrahim
- Clinical Microbiology Unit, Pasteur Institute of Lille, Lille, France
- European Institute for Emerging Antibiotic Resistance, Pasteur Institute, Lille, France
- European Institute for Emerging Antibiotic Resistance, University of Fribourg, Fribourg, Switzerland
| | - Maxime Bouvier
- Medical and Molecular Microbiology, University of Fribourg, Fribourg, Switzerland
| | - Mustafa Sadek
- Medical and Molecular Microbiology, University of Fribourg, Fribourg, Switzerland
- Department of Food Hygiene and Control, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Jean-Winoc Decousser
- Equipe Opérationnelle d’Hygiène, Département Prévention, Diagnostic, Traitement des Infections, Hôpitaux Universitaires Henri-Mondor AP-HP, Créteil, France
- DYNAMYC, University Paris Est Creteil, Créteil, France
- DYNAMYC, EnvA, Maisons-Alfort, France
| | - Laurent Poirel
- European Institute for Emerging Antibiotic Resistance, Pasteur Institute, Lille, France
- Medical and Molecular Microbiology, University of Fribourg, Fribourg, Switzerland
- European Institute for Emerging Antibiotic Resistance, University of Fribourg, Fribourg, Switzerland
| | - Patrice Nordmann
- European Institute for Emerging Antibiotic Resistance, Pasteur Institute, Lille, France
- Medical and Molecular Microbiology, University of Fribourg, Fribourg, Switzerland
- European Institute for Emerging Antibiotic Resistance, University of Fribourg, Fribourg, Switzerland
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Quirino A, Cicino C, Scaglione V, Marascio N, Serapide F, Scarlata GGM, Lionello R, Divenuto F, La Gamba V, Pavia G, Russo A, Torti C, Matera G, Trecarichi EM. In vitro Activity of Cefiderocol Against Carbapenem-Resistant Acinetobacter baumannii Clinical Isolates: a Single Center Experience. Mediterr J Hematol Infect Dis 2023; 15:e2023043. [PMID: 37435038 PMCID: PMC10332354 DOI: 10.4084/mjhid.2023.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023] Open
Affiliation(s)
- Angela Quirino
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University of Catanzaro–“Mater Domini” teaching hospital; Catanzaro, Italy
| | - Claudia Cicino
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University of Catanzaro–“Mater Domini” teaching hospital; Catanzaro, Italy
| | - Vincenzo Scaglione
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro – “Mater Domini” teaching hospital; Catanzaro, Italy
| | - Nadia Marascio
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University of Catanzaro–“Mater Domini” teaching hospital; Catanzaro, Italy
| | - Francesca Serapide
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro – “Mater Domini” teaching hospital; Catanzaro, Italy
| | - Giuseppe Guido Maria Scarlata
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University of Catanzaro–“Mater Domini” teaching hospital; Catanzaro, Italy
| | - Rosaria Lionello
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro – “Mater Domini” teaching hospital; Catanzaro, Italy
| | - Francesca Divenuto
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University of Catanzaro–“Mater Domini” teaching hospital; Catanzaro, Italy
| | - Valentina La Gamba
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro – “Mater Domini” teaching hospital; Catanzaro, Italy
| | - Grazia Pavia
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University of Catanzaro–“Mater Domini” teaching hospital; Catanzaro, Italy
| | - Alessandro Russo
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro – “Mater Domini” teaching hospital; Catanzaro, Italy
| | - Carlo Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro – “Mater Domini” teaching hospital; Catanzaro, Italy
| | - Giovanni Matera
- Unit of Clinical Microbiology, Department of Health Sciences, “Magna Graecia” University of Catanzaro–“Mater Domini” teaching hospital; Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University of Catanzaro – “Mater Domini” teaching hospital; Catanzaro, Italy
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Nayak G, Behera B, Mohanty S, Kar P, Jena J. Analysis of In Vitro Activity of Cefiderocol Against Carbapenem-Resistant Gram-Negative Bacilli by Broth Microdilution and Disk Diffusion Method: A Single-Center Study in Odisha, India. Infect Drug Resist 2022; 15:5887-5897. [PMID: 36237292 PMCID: PMC9553237 DOI: 10.2147/idr.s378579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Cefiderocol (CFDC), a novel semi-synthetic siderophore cephalosporin has been developed to combat the menace of infections caused by carbapenem-resistant Gram-negative bacilli (CR-GNB) including Carbapenem-resistant Enterobacterales (CRE) and Carbapenem-resistant Nonfermenting Gram-negative bacilli (CR-NFGNB). Methods We determined the in vitro activity of CFDC against a contemporary collection of 503 CR-GNB isolates by the reference broth microdilution method (BMD) using Iron depleted cation adjusted Mueller-Hinton broth (ID-CAMHB). Performance of CFDC disk diffusion (DD) was evaluated against the reference BMD, as an alternative convenient testing method. Molecular characterization of carbapenemase in CR-GNB was performed by PCR targeting bla NDM-1, bla OXA-48like alleles, bla KPC, bla IMP, and, bla VIM. Minimum inhibitory concentration (MIC) distribution of CFDC in CR-GNB harbouring different carbapenemase enzymes was also analyzed. Results In our study, 81.7% (411/503) of CR-GNB isolates [81.3%, (278/342) CRE and 82.6% (133/161) CR-NFGNB] were susceptible to CFDC (p>0.05). Categorical agreement (CA) of DD ranged from 79.8% to 87.5%, Minor error (mE) ranged from 0 to 14%, Major error (ME) ranged from 0 to 3.5%, and Very Major error (VME) ranged from 0 to 12.5% with variations by species tested. Overall CFDC MIC50 and MIC90 values of CR-GNB isolates without any carbapenemase genes were higher as compared to those with the presence of carbapenemase genes (4 µg/mL and 128 µg/mL versus 2 µg/mL and 16 µg/mL respectively). Discussion CFDC is not yet available for clinical use in India. Hence, multicentric studies are the need of the hour in India for standardization of CFDC susceptibility using disks and CAMHB from different manufacturers as well as understanding mechanisms of high MIC values.
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Affiliation(s)
- Gayatree Nayak
- Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, 751019, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, 751019, India,Correspondence: Bijayini Behera, Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, 751019, India, Tel +07750847562, Email
| | - Srujana Mohanty
- Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, 751019, India
| | - Punyatoya Kar
- Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, 751019, India
| | - Jayanti Jena
- Department of Microbiology, All India Institute of Medical Sciences [AIIMS], Bhubaneswar, Odisha, 751019, India
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Li X, Zhao J, Zhang B, Duan X, Jiao J, Wu W, Zhou Y, Wang H. Drug development concerning metallo-β-lactamases in gram-negative bacteria. Front Microbiol 2022; 13:959107. [PMID: 36187949 PMCID: PMC9520474 DOI: 10.3389/fmicb.2022.959107] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
β-Lactams have been a clinical focus since their emergence and indeed act as a powerful tool to combat severe bacterial infections, but their effectiveness is threatened by drug resistance in bacteria, primarily by the production of serine- and metallo-β-lactamases. Although once of less clinical relevance, metallo-β-lactamases are now increasingly threatening. The rapid dissemination of resistance mediated by metallo-β-lactamases poses an increasing challenge to public health worldwide and comprises most existing antibacterial chemotherapies. Regrettably, there have been no clinically available inhibitors of metallo-β-lactamases until now. To cope with this unique challenge, researchers are exploring multidimensional strategies to combat metallo-β-lactamases. Several studies have been conducted to develop new drug candidates or calibrate already available drugs against metallo-β-lactamases. To provide an overview of this field and inspire more researchers to explore it further, we outline some promising candidates targeting metallo-β-lactamase producers, with a focus on Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Promising candidates in this review are composed of new antibacterial drugs, non-antibacterial drugs, antimicrobial peptides, natural products, and zinc chelators, as well as their combinations with existing antibiotics. This review may provide ideas and insight for others to explore candidate metallo-β-lactamases as well as promote the improvement of existing data to obtain further convincing evidence.
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Affiliation(s)
- Xiuyun Li
- Maternal and Child Health Development Research Center, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Jing Zhao
- Pharmaceutical Department, Shandong Provincial Taishan Hospital, Taian, China
| | - Bin Zhang
- Department of Ophthalmology, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Xuexia Duan
- Physical Examination Center, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Jin Jiao
- Department of Clinical Laboratory, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Weiwei Wu
- Department of Clinical Laboratory, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Yuxia Zhou
- Department of Clinical Laboratory, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
- *Correspondence: Yuxia Zhou
| | - Hefeng Wang
- Department of Pediatric Surgery, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
- Hefeng Wang
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