article.page.titleprefix Higher rates of cefiderocol resistance among NDM producing Klebsiella bloodstream isolates applying EUCAST over CLSI breakpoints
Date
2023-06-30
Journal Title
Journal ISSN
Volume Title
Publisher
Infectious Diseases
Abstract
Background: Cefiderocol is generally active against carbapenem-resistant Klebsiella spp. (CRK) with higher MICs against
metallo-beta-lactamase producers. There is a variation in cefiderocol interpretive criteria determined by EUCAST and
CLSI. Our objective was to test CRK isolates against cefiderocol and compare cefiderocol susceptibilities using EUCAST
and CLSI interpretive criteria.
Methods: A unique collection (n ¼ 254) of mainly OXA-48-like- or NDM-producing CRK bloodstream isolates were tested
against cefiderocol with disc diffusion (Mast Diagnostics, UK). Beta-lactam resistance genes and multilocus sequence
types were identified using bioinformatics analyses on complete bacterial genomes.
Results: Median cefiderocol inhibition zone diameter was 24 mm (interquartile range [IQR] 24–26 mm) for all isolates
and 18 mm (IQR 15–21 mm) for NDM producers. We observed significant variability between cefiderocol susceptibilities
using EUCAST and CLSI breakpoints, such that 26% and 2% of all isolates, and 81% and 12% of the NDM producers
were resistant to cefiderocol using EUCAST and CLSI interpretive criteria, respectively.
Conclusions: Cefiderocol resistance rates among NDM producers are high using EUCAST criteria. Breakpoint variability
may have significant implications on patient outcomes. Until more clinical outcome data are available, we suggest using
EUCAST interpretive criteria for cefiderocol susceptibility testing.
Description
Open Access, Published by Infectious Diseases, https://doi.org/10.1080/23744235.2023.2226709, Burcu Isler, et al.
Keywords
Cefiderocol, NDM, EUCAST, CLSI, Klebsiella, bloodstream
Citation
http://hdl.handle.net/20.500.14411/1914