Treatment-emergent cefiderocol resistance in carbapenem-resistant Acinetobacter baumannii is associated with insertion sequence IS Aba36 in the siderophore receptor pirA

Antimicrob Agents Chemother. 2024 Jul 9;68(7):e0029024. doi: 10.1128/aac.00290-24. Epub 2024 May 29.

Abstract

We report the emergence of cefiderocol resistance in a blaOXA-72 carbapenem-resistant Acinetobacter baumannii isolate from a sacral decubitus ulcer. Cefiderocol was initially used; however, a newly approved sulbactam-durlobactam therapy with source control and flap coverage was successful in treating the infection. Laboratory investigation revealed cefiderocol resistance mediated by ISAba36 insertion into the siderophore receptor pirA.

Keywords: Acinetobacter baumannii; ISAba36; OXA-72; carbapenem resistance; cefiderocol; sulbactam-durlobactam.

Publication types

  • Case Reports

MeSH terms

  • Acinetobacter Infections* / drug therapy
  • Acinetobacter Infections* / microbiology
  • Acinetobacter baumannii* / drug effects
  • Acinetobacter baumannii* / genetics
  • Anti-Bacterial Agents* / pharmacology
  • Azabicyclo Compounds / pharmacology
  • Bacterial Outer Membrane Proteins
  • Carbapenems* / pharmacology
  • Cefiderocol*
  • Cephalosporins* / pharmacology
  • DNA Transposable Elements / genetics
  • Drug Resistance, Multiple, Bacterial / genetics
  • Humans
  • Male
  • Microbial Sensitivity Tests*
  • Receptors, Cell Surface / genetics
  • Receptors, Cell Surface / metabolism
  • Sulbactam / pharmacology

Substances

  • Cefiderocol
  • Anti-Bacterial Agents
  • Cephalosporins
  • Carbapenems
  • Receptors, Cell Surface
  • siderophore receptors
  • Sulbactam
  • durlobactam
  • Azabicyclo Compounds
  • DNA Transposable Elements
  • Bacterial Outer Membrane Proteins