Tsai Shemual, Nigo Masayuki, Kang Donghoon, Baptista Rodrigo P, Tamma Pranita D, Jacobs Emily, Bergman Yehudit, Victor David W, Connor Ashton A, Saharia Ashish, Ghobrial R Mark, Arias Cesar A, Miller William R
Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA.
Division of Infectious Diseases and Center for Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston, TX, USA.
JAC Antimicrob Resist. 2025 Jul 17;7(4):dlaf129. doi: 10.1093/jacamr/dlaf129. eCollection 2025 Aug.
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 and isolates that developed cefiderocol resistance on therapy treated successfully with cefepime-zidebactam.
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.
Index isolates of (IMP positive) and (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 and were cefiderocol resistant by broth microdilution. Cefepime-zidebactam remained active with MICs of 8/8 mg/L and 32/32 mg/L, respectively. The patient did well post-transplant and resumed chemotherapy.
Antimicrobial therapy with cefepime-zidebactam along with source control allowed successful liver transplantation in a patient with cefiderocol-resistant and . Cefepime-zidebactam may be a therapeutic option for extensively drug-resistant Gram-negative organisms.
耐抗菌药物的革兰氏阴性菌感染带来了日益严峻的治疗挑战，尤其是在存在金属β-内酰胺酶的情况下。我们报告了一例因[具体细菌名称1]和[具体细菌名称2]分离株导致胆管炎的患者，该患者在接受头孢地尔治疗时出现耐药，最终使用头孢吡肟-他唑巴坦成功治疗。
通过肉汤微量稀释法检测从胆汁和腹水中分离出的系列临床分离株对头孢地尔、氨曲南-阿维巴坦、头孢吡肟-坦尼硼巴坦、头孢吡肟-他唑巴坦和头孢地尔-西鲁巴坦的敏感性。进行全基因组测序以鉴定耐药决定因素。基于药敏试验结果，美国食品药品监督管理局批准了一项紧急研究性新药申请，允许同情用药使用头孢吡肟-他唑巴坦。
在临床微生物实验室中，[具体细菌名称1]（IMP阳性）和[具体细菌名称2]（NDM-5、OXA-232阳性）的初始分离株通过纸片扩散法检测对头孢地尔敏感。患者接受了头孢地尔和依拉环素治疗方案，但持续发热，影像学检查发现肝脏微脓肿。在肝移植前一天开始同情用药头孢吡肟-他唑巴坦治疗，由于手术期间腹水培养阳性，共持续治疗14天。通过肉汤微量稀释法检测，[具体细菌名称1]和[具体细菌名称2]对头孢地尔耐药。头孢吡肟-他唑巴坦仍具有活性，MIC分别为8/8mg/L和32/32mg/L。患者移植后情况良好，恢复了化疗。
头孢吡肟-他唑巴坦抗菌治疗联合源头控制使一名对头孢地尔耐药的[具体细菌名称1]和[具体细菌名称2]感染患者成功进行了肝移植。头孢吡肟-他唑巴坦可能是治疗广泛耐药革兰氏阴性菌的一种治疗选择。
