Beyond Carbapenemases: Chromosomal Resistance Mechanisms and Carbapenemase Type Determine Susceptibility to Novel β-Lactam/β-Lactamase Inhibitor Combinations and Cefiderocol in Carbapenem-Resistant

Jiankang Zhao, Yanyan Fan, Bin Cao

Abstract read

In one paragraph

Article in Antibiotics (Basel, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it

0cells of the map it votes in

0citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Jiankang ZhaoNational Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, New Cornerstone Science Laboratory, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China.ORCID 0000-0002-2758-2034

Yanyan FanNational Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, New Cornerstone Science Laboratory, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China.

Bin CaoNational Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, New Cornerstone Science Laboratory, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China.

Funding

Horizontal Research Project of China-Japan Friendship Hospital 2024-HX-JC-22, 2025-HX-211

6 · The paper itself

Abstract

backgroundβ-lactam/β-lactamase inhibitor combinations (BL/BLIs) and siderophore cephalosporin serve as critical polymyxin alternatives for carbapenem-resistant

methodsWe collected 442 CRPA isolates from 10 hospitals across eight Chinese provinces (2017-2025), determined minimum inhibitory concentrations (MICs) for cefiderocol (FDC), ceftazidime-avibactam (CZA), imipenem-relebactam (IMR), and ceftolozane-tazobactam (CT) through broth microdilution, and performed whole-genome sequencing. Resistance genes, virulence factors, and sequence types (STs) were identified. A chromosomal co-selection score (eight non-mobile resistance genes) was constructed. Multivariable regression and receiver operating characteristic (ROC) analysis identified predictors of non-susceptibility.

resultsCarbapenemase genes were detected in only 33 isolates (7.5%): metallo β lactamase (MBL) genes in 28,

conclusionsMechanisms other than acquired carbapenemases-consistent with chromosomal determinants-accounted for most non-susceptibility in this predominantly northern Chinese respiratory tract CRPA collection. Carbapenemase types determine distinct drug susceptibility patterns. Routine carbapenemase detection fails to identify most CZA-resistant strains. FDC retained the broadest in vitro activity and is a reliable therapeutic option pending clinical outcome data, and ST270-associated resistance deserves continuous surveillance.

Indexed as

carbapenemase genescarbapenem-resistant Pseudomonas aeruginosacefiderocolchromosomal resistance mechanismsβ-lactam/β-lactamase inhibitors

Identifiers

PMID42791985

DOI10.3390/antibiotics15090835

PMCPMC13603519

What OpenQuestion holds

Textmetadata

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.