Clinical Evolution of AmpC-Mediated Ceftazidime-Avibactam and Cefiderocol Resistance in <i>Enterobacter cloacae</i> Complex Following Exposure to Cefepime
Ryan K. Shields, Alina Iovleva, Ellen G Kline, Akito Kawai, Christi L. McElheny, Yohei Doi
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.
Topics & Concepts
CefepimeEnterobacter cloacaeCeftazidime/avibactamCephalosporinCeftazidimeMicrobiologyBiologyEnterobacterSiderophoreAvibactamPolymyxinChemistryEnterobacteriaceaeBacteriaAntibioticsPseudomonas aeruginosaBiochemistryGeneticsEscherichia coliGeneAntibiotic Resistance in BacteriaAntibiotics Pharmacokinetics and EfficacyInfections and bacterial resistance