ArticleCurrent microbiology2026
β-Lactamase-Driven Resistance to Cefiderocol in Carbapenem-Resistant Pseudomonas aeruginosa and its Reversal by Avibactam.
Article in Current microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Postoperative Nocardia cyriacigeorgica infection after glioblastoma resection: correlating metagenomic next-generation sequencing with conventional microbiology.Naunyn-Schmiedeberg's archives of pharmacology · 2026Article
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Abstract
Pseudomonas aeruginosa remains one of the most formidable Gram-negative pathogens due to its extensive β-lactamase repertoire and rapidly evolving multidrug resistance. Cefiderocol, a novel siderophore cephalosporin, has emerged as a promising option against carbapenem-resistant isolates; however, its activity may be compromised in the presence of class A β-lactamases. Avibactam, a potent inhibitor of class A, class C, and selected class D β-lactamases, offers a rational strategy to restore cefiderocol efficacy. In this study, the in vitro activity of cefiderocol alone and in combination with avibactam was evaluated against 38 non-duplicate clinical carbapenem-resistant P. aeruginosa isolates collected at Hacettepe University. Antimicrobial susceptibility was assessed by disc diffusion, gradient test, and broth microdilution, while β-lactamase genes were identified by PCR and sequencing. The cefiderocol–avibactam combination was tested using a fixed avibactam concentration of 4 mg/L. Cefiderocol resistance was detected in 84.2% of isolates, with blaVEB, blaPER, and blaVIM being the most prevalent resistance determinants. Notably, the addition of avibactam produced a pronounced ≥ 8.5-fold mean reduction in cefiderocol minimum inhibitory concentrations among class A β-lactamase producers and restored susceptibility in 21 of 36 resistant isolates, whereas metallo-β-lactamase–producing strains showed minimal response. Overall, the cefiderocol–avibactam combination demonstrated significantly enhanced in vitro activity compared with cefiderocol alone (p < 0.00001), underscoring its potential clinical value as a rescue therapeutic option for infections caused by extended-spectrum β-lactamase–producing, carbapenem-resistant P. aeruginosa.
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