1. Assessment of the activity and mechanisms of resistance to cefiderocol and combinations of β-lactams and the novel β-lactamase inhibitors avibactam, taniborbactam, zidebactam, nacubactam, xeruborbactam, and ANT3310 in emerging double-carbapenemase-producing Enterobacterales.
- Author
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Blanco-Martín T, López-Hernández I, Aracil B, González-Pinto L, Aja-Macaya P, Alonso-García I, Rodríguez-Pallares S, Sánchez-Peña L, Outeda-García M, Pérez-Vázquez M, Vázquez-Ucha JC, Beceiro A, Pascual Á, Bou G, López-Cerero L, Oteo-Iglesias J, and Arca-Suárez J
- Subjects
- Boronic Acids pharmacology, Ceftazidime pharmacology, Cyclooctanes pharmacology, Humans, Drug Combinations, Cefepime pharmacology, Borinic Acids pharmacology, Aztreonam pharmacology, beta-Lactams pharmacology, Carbapenem-Resistant Enterobacteriaceae drug effects, Carbapenem-Resistant Enterobacteriaceae genetics, Enterobacteriaceae drug effects, Enterobacteriaceae genetics, Drug Resistance, Multiple, Bacterial genetics, Carboxylic Acids, Lactams, Piperidines, Microbial Sensitivity Tests, Azabicyclo Compounds pharmacology, beta-Lactamases genetics, beta-Lactamases metabolism, Anti-Bacterial Agents pharmacology, beta-Lactamase Inhibitors pharmacology, Bacterial Proteins genetics, Bacterial Proteins metabolism, Cephalosporins pharmacology, Heterocyclic Compounds, 1-Ring pharmacology, Cefiderocol
- Abstract
We aimed to investigate the activity of and mechanisms of resistance to cefiderocol and innovative β-lactam/β-lactamase inhibitor combinations in a nationwide collection of double-carbapenemase-producing Enterobacterales. In all, 57 clinical isolates co-producing two carbapenemases collected from Spanish hospitals during the period 2017-2022 were analyzed. Minimum inhibitory concentration (MIC) values for ceftazidime, ceftazidime/avibactam, aztreonam, aztreonam/avibactam, aztreonam/nacubactam, cefiderocol, cefepime, cefepime/taniborbactam, cefepime/zidebactam, cefepime/nacubactam, imipenem, imipenem/relebactam, meropenem, meropenem/vaborbactam, meropenem/xeruborbactam, and meropenem/ANT3310 were determined by reference broth microdilution. Genetic drivers of resistance were analyzed by whole-genome sequencing (WGS). The collection covered nine carbapenemase associations: VIM + OXA-48 (21/57), NDM + OXA-48 (11/57), KPC + VIM (10/57), KPC + OXA-48 (6/57), IMP + OXA-48 (3/57), NDM + KPC (2/57), NDM + VIM (2/57), NDM + GES (1/57), and KPC + IMP (1/57). Ceftazidime/avibactam, imipenem/relebactam, and meropenem/vaborbactam were the least active options. Aztreonam/avibactam and aztreonam/nacubactam were active against the whole collection and yielded MIC
50 /MIC90 values of ≤0.25/0.5 mg/L and 1/2 mg/L, respectively. Cefepime/zidebactam (56/57 susceptible), meropenem/xeruborbactam (56/57 susceptible), cefepime/nacubactam (55/57 susceptible), and cefiderocol (53/57 susceptible) were also highly active, with MIC50 /MIC90 values ranging from ≤0.25-2 mg/L to 2-4 mg/L, respectively. Meropenem/ANT3310 (MIC50 /MIC90 = 0.5/≥64 mg/L; 47/57 susceptible) and cefepime/taniborbactam (MIC50 /MIC90 = 0.5/16 mg/L; 44/57 susceptible) also retained high levels of activity, although they were affected by NDM-type enzymes in combination with porin deficiency. Our findings highlight that cefiderocol and combinations of β-lactams and the novel β-lactamase inhibitors avibactam, nacubactam, taniborbactam, zidebactam, xeruborbactam, and ANT3310 show promising activity against double-carbapenemase-producing Enterobacterales., Competing Interests: Merck Sharp & Dohme (MSD) provided relebactam powder, and cefiderocol was provided by Shionoghi. Commercial suppliers did not exercise any control over the conduct or reporting of the research. J.C.V.-U. has received honoraria for lectures and/or presentations from MSD. G.B. has received funding and study materials from MSD, grants contracts from MSD, Pfizer, ABAC Therapeutics, and Roche, and consulting fees and honoraria for lectures and/or presentations from MSD, Shionogi, Pfizer, and Roche. J.A.-S. has received honoraria for lectures and/or presentations from MSD, Shionogi, Pfizer, Roche, and Advanz.- Published
- 2024
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