Hanna Sidonie, La Kevin, Yoshii Yutaka, Gits-Muselli Maud, El Meouche Imane, Benhadid-Brahmi Yasmine, Bonacorsi Stéphane, Birgy André
IAME, UMR 1137, INSERM, Université Paris Cité, Paris, France.
Service de Microbiologie, Hôpital Robert-Debré, AP-HP, Paris, France.
Sci Rep. 2025 Aug 25;15(1):31312. doi: 10.1038/s41598-025-17044-8.
Klebsiella pneumoniae carbapenemase (KPC) is a frequent and widespread carbapenemase, with over 260 variants identified. While KPC often evolves resistance to ceftazidime-avibactam, cefiderocol remains a key treatment option. Some variants, such as KPC-33 (D179Y), reduce cefiderocol susceptibility, but typically with only modest MIC increases. However, KPC's genetic adaptability raises concern that further mutations could lead to high-level resistance, compromising cefiderocol's efficacy. To anticipate this risk, we explored the mutational potential of bla, bla, and bla using random mutagenesis followed by 10-day selection under increasing cefiderocol pressure and whole genome sequencing. Libraries of 10, 10, and 10 mutants, respectively, yielded isolates with significantly elevated MICs, some exceeding 32 mg/L. All resistant clones shared a phenotype marked by cross-resistance to cefiderocol, ceftazidime, ceftazidime-avibactam, cefixime, and piperacillin, but restored susceptibility to carbapenems and most other β-lactams. Our findings highlight that no single mutation enables KPC to efficiently hydrolyze cefiderocol. Instead, high-level resistance requires a combination of enzymatic mutations and chromosomal alterations-such as disruptions in cirA and ybiX-suggesting a multifactorial and stepwise evolutionary pathway. Notably, ybiX has not previously been associated with cefiderocol resistance. These results underscore the importance of ongoing surveillance to detect emerging cefiderocol resistance in KPC-producing Enterobacterales.
肺炎克雷伯菌碳青霉烯酶(KPC)是一种常见且广泛存在的碳青霉烯酶,已鉴定出超过260种变体。虽然KPC常常对头孢他啶-阿维巴坦产生耐药性,但头孢地尔仍然是一种关键的治疗选择。一些变体,如KPC-33(D179Y),会降低对头孢地尔的敏感性,但通常只是最低抑菌浓度(MIC)略有增加。然而,KPC的遗传适应性引发了人们的担忧,即进一步的突变可能导致高水平耐药,从而损害头孢地尔的疗效。为了预测这种风险,我们利用随机诱变,随后在不断增加的头孢地尔压力下进行10天的筛选以及全基因组测序,探索了blaKPC、blaSHV和blaCTX-M的突变潜力。分别构建了10⁶、10⁷和10⁸个突变体文库,得到了MIC显著升高的分离株,有些超过了32 mg/L。所有耐药克隆都具有对头孢地尔、头孢他啶、头孢他啶-阿维巴坦、头孢克肟和哌拉西林交叉耐药的表型,但对碳青霉烯类和大多数其他β-内酰胺类药物的敏感性恢复。我们的研究结果表明,没有单一突变能使KPC有效地水解头孢地尔。相反,高水平耐药需要酶促突变和染色体改变(如cirA和ybiX的破坏)相结合,这表明存在一个多因素且逐步的进化途径。值得注意的是,ybiX以前并未与头孢地尔耐药性相关联。这些结果强调了持续监测以检测产KPC的肠杆菌科细菌中出现的头孢地尔耐药性的重要性。