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在治疗过程中，产碳青霉烯酶阴沟肠杆菌对头孢他啶的耐药性迅速发展与儿茶酚载体铁载体受体 cirA 中的异质性突变有关。

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

机构信息

Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg,Germany.

Department of Anesthesiology, Heidelberg University Hospital, Heidelberg,Germany.

出版信息

Clin Infect Dis. 2022 Mar 9;74(5):905-908. doi: 10.1093/cid/ciab511.

DOI:10.1093/cid/ciab511
PMID:34079986
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8906715/
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.

摘要

我们报告了一例患者在接受头孢地尔治疗 21 天内，出现对产碳青霉烯酶阴沟肠杆菌引起的腹腔内和血流感染的头孢地尔耐药的情况。全基因组测序显示，编码儿茶酚载体 siderophore 受体的 cirA 基因存在异质性突变，赋予了对头孢地尔的表型耐药性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0c0/8906715/0fc4b7166883/ciab511f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0c0/8906715/0fc4b7166883/ciab511f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0c0/8906715/0fc4b7166883/ciab511f0001.jpg

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本文引用的文献

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US Food and Drug Administration (FDA): Benefit-Risk Considerations for Cefiderocol (Fetroja®).美国食品药品监督管理局（FDA）：头孢地尔（Fetroja®）的获益-风险考量。
Clin Infect Dis. 2021 Jun 15;72(12):e1103-e1111. doi: 10.1093/cid/ciaa1799.
2
Activity of Cefiderocol, a Siderophore Cephalosporin, against Multidrug-Resistant Gram-Negative Bacteria.头孢他啶美罗培南复方制剂（cefiderocol）对多重耐药革兰氏阴性菌的活性。
Antimicrob Agents Chemother. 2020 Nov 17;64(12). doi: 10.1128/AAC.01582-20.
3
Structural Basis of Reduced Susceptibility to Ceftazidime-Avibactam and Cefiderocol in Due to AmpC R2 Loop Deletion.
产碳青霉烯酶肠杆菌科细菌对头孢地尔耐药的机制：比较基因组学研究见解
Antibiotics (Basel). 2025 Jul 12;14(7):703. doi: 10.3390/antibiotics14070703.
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Cefiderocol "under siege"? Understanding the rise of NDM-mediated resistance to novel agents.头孢地尔“被围攻”？解读NDM介导的对新型药物耐药性的上升。
Chem Sci. 2025 Jun 3. doi: 10.1039/d5sc02122g.
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因AmpC R2环缺失导致对头孢他啶-阿维巴坦和头孢地尔耐药性降低的结构基础。
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Int J Antimicrob Agents. 2019 Feb;53(2):177-184. doi: 10.1016/j.ijantimicag.2018.10.007. Epub 2018 Oct 26.