Cefepime-zidebactam therapy for extensively drug-resistant Pseudomonas aeruginosa and Klebsiella pneumoniae infection as a bridge to liver transplantation

作者：Shemual Tsai, Masayuki Nigo, Donghoon Kang, Rodrigo P. Baptista, Pranita D. Tamma, Emily Jacobs, Yehudit Bergman, David W. Victor, Ashton A. Connor, Ashish Saharia, R. Mark Ghobrial, César A. Arias, William R. Miller · 发表于：JAC-Antimicrobial Resistance · 年份：2025 · DOI：10.1093/jacamr/dlaf129 · 被引用次数：9 · 研究领域：Antibiotic Resistance in Bacteria、Antibiotics Pharmacokinetics and Efficacy、Infections and bacterial resistance

Abstract Background Infections due to antimicrobial-resistant Gram-negative organisms present increasingly difficult therapeutic challenges, especially in the presence of metallo-β-lactamases. We present the case of a patient with cholangitis due to Pseudomonas aeruginosa and Klebsiella pneumoniae isolates that developed cefiderocol resistance on therapy treated successfully with cefepime-zidebactam. Methods Serial clinical isolates recovered from biliary fluid and ascitic fluid were tested for susceptibility to cefiderocol, aztreonam-avibactam, cefepime-taniborbactam, cefepime-zidebactam, and cefiderocol-xeruborbactam by broth microdilution. Whole-genome sequencing was performed to identify resistance determinants. An emergency investigational new drug application was authorized by the United States Food and Drug Administration for the compassionate use of cefepime-zidebactam based on susceptibility test results. Results Index isolates of P. aeruginosa (IMP positive) and K. pneumoniae (NDM-5, OXA-232 positive) tested susceptible to cefiderocol by disk diffusion in the clinical microbiology laboratory. The patient was treated with a regimen of cefiderocol and eravacycline, with persistent fever and development of hepatic microabscesses on imaging. Compassionate use cefepime-zidebactam therapy was initiated the day prior to liver transplantation and continued for a total of 14 days due to positive ascitic fluid cultures obtained during the operation. The K. pneumoniae and P. a...