Sequential Treatment Failure With Aztreonam-Ceftazidime-Avibactam Followed by Cefiderocol Due to Preexisting and Acquired Mechanisms in a New Delhi Metallo-β-lactamase–Producing Escherichia coli Causing Fatal Bloodstream Infection

Author:

Senchyna Fiona1,Murugesan Kanagavel1,Rotunno William2,Nadimpalli Sruti S3,Deresinski Stan4,Banaei Niaz124ORCID

Affiliation:

1. Department of Pathology, Stanford University School of Medicine , Stanford, California , USA

2. Clinical Microbiology Laboratory, Stanford University Medical Center , Palo Alto, California , USA

3. Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine , Stanford, California , USA

4. Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine , Stanford, California , USA

Abstract

Abstract We report a fatal case of New Delhi metallo-β-lactamase (NDM)–producing Escherichia coli in a bacteremic patient with sequential failure of aztreonam plus ceftazidime-avibactam followed by cefiderocol. Acquired resistance was documented phenotypically and mediated through preexisting and acquired mutations. This case highlights the need to rethink optimal treatment for NDM-producing organisms.

Funder

Stanford Department of Pathology

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

Reference19 articles.

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2. Comparative genomics of Enterobacter cloacae complex before and after acquired clinical resistance to ceftazidime-avibactam;Senchyna;Diagn Microbiol Infect Dis,2021

3. CARD 2020: antibiotic resistome surveillance with the Comprehensive Antibiotic Resistance Database;Alcock;Nucleic Acids Res,2020

4. Genetic features leading to reduced susceptibility to aztreonam-avibactam among metallo-beta-lactamase-producing Escherichia coli isolates;Sadek;Antimicrob Agents Chemother,2020

5. Occurrence of high levels of cefiderocol resistance in carbapenem-resistant Escherichia coli before its approval in China: a report from China CRE-network;Wang;Microbiol Spectr,2022

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