Rapid Development of Cefiderocol Resistance in Carbapenem-resistant Enterobacter cloacae During Therapy Is Associated With Heterogeneous Mutations in the Catecholate Siderophore Receptor cirA.

Klein, Sabrina; Boutin, Sébastien; Kocer, Kaan; Fiedler, Mascha O; Störzinger, Dominic; Weigand, Markus A; Tan, Benjamin; Richter, Daniel et al. · Clin Infect Dis · 2022

case_report · Level V

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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.

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