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In vitro activity of cefiderocol against clinically relevant Gram-negative bacilli collected in China in 2023
Dandan Yin1, Fangfang Zhang2, Yan Guo1
1Huashan Hospital, Institute of Antibiotics, Fudan University, Shanghai, China; Key Laboratory of Clinical Pharmacology of Antibiotics, Ministry of Health, Shanghai, China; Joint Laboratory of Hospital & Enterprise for Pathogen Diagnosis of Drug-resistant Bacterial Infections and Innovative Drug R&D, Shanghai, China.
Objective:
Cefiderocol is a siderophore-conjugated cephalosporin with potent in vitro activity against aerobic Gram-negative bacteria, including Enterobacterales and glucose-nonfermenting species. This study aimed to explore the in vitro activity of cefiderocol against 2049 clinical isolates collected from 63 hospitals across China in 2023.
Methods:
Antimicrobial susceptibility testing was performed using broth microdilution following Clinical and Laboratory Standards Institute (CLSI) 2024 guidelines for Enterobacterales (n = 993), Pseudomonas aeruginosa (n = 377), Acinetobacter baumannii (n = 368), Stenotrophomonas maltophilia (n = 188) and Burkholderia cepacia (n = 123). Results were interpreted by CLSI breakpoints.
Results:
Cefiderocol had potent in vitro activity against Enterobacterales (susceptibility rates: 93.5%-100%, minimum inhibitory concentrations inhibiting 90% of isolates [MIC90]: 0.25-4 µg/mL). For meropenem-resistant Escherichia coli and Klebsiella pneumoniae, the MIC90 values were 8 µg/mL and 4 µg/mL, and susceptibility rates were 86.4% and 91.0%, respectively. For 11 meropenem-resistant Enterobacter cloacae, susceptibility rate was 36.4% (MIC90: 16 µg/mL). Susceptibility rates for P. aeruginosa, A. baumannii and S. maltophilia were 99.7%, 99.5% and 98.4% overall, and 98.6% and 99.1% for meropenem-resistant P. aeruginosa and A. baumannii, respectively. The MIC90 value for B. cepacia was 0.25 µg/mL and 100% of isolates had cefiderocol MIC values ≤2 µg/mL. Cefiderocol had similar in vitro activity to colistin and tigecycline, and it was more active than ceftazidime-avibactam and imipenem-relebactam against meropenem-resistant E. coli, K. pneumoniae and P. aeruginosa.
Conclusions:
Cefiderocol showed potent in vitro activity against most Gram-negative species collected in China; however, continuous surveillance of resistance patterns, particularly for E. cloacae, is essential to ensure its long-term effectiveness.
