Rapid Development of Cefiderocol Resistance in Carbapenem-resistant <i>Enterobacter cloacae</i> During Therapy Is Associated With Heterogeneous Mutations in the Catecholate Siderophore Receptor <i>cirA</i>
Sabrina Klein, Sébastien Boutin, Kaan Kocer, Mascha O. Fiedler, Dominic Störzinger, Markus Weigand, Benjamin Tan, Daniel Richter, Christian Rupp, Markus Mieth, Arianeb Mehrabi, Thilo Hackert, Stefan Zimmermann, Klaus Heeg, Dennis Nurjadi
Abstract
We report a case of resistance development toward cefiderocol in a patient with intra-abdominal and bloodstream infections caused by carbapenemase-producing Enterobacter cloacae within 21 days of cefiderocol therapy. Whole genome sequencing revealed heterogeneous mutations in the cirA gene, encoding a catecholate siderophore receptor, conferring phenotypic resistance to cefiderocol.
Topics & Concepts
Enterobacter cloacaeSiderophoreMedicineMicrobiologyEnterobacterCarbapenemGram-negative bacterial infectionsEnterobacteriaceaeBiologyBacteriaGeneticsAntibioticsGeneEscherichia coliAntibiotic Resistance in BacteriaAntibiotics Pharmacokinetics and EfficacyCystic Fibrosis Research Advances