Frequency of Susceptibility to Cefiderocol in Carbapenem-Resistant Gram-Negative Bacteria by Kirby-Bauer Disc Diffusion Method; A Study in Tertiary Care Hospital of Southern Punjab
Article Sidebar
Main Article Content
Abstract
Objective:
The study was planned to assess the frequency of susceptibility to Cefiderocol in carbapenem-resistant gram-negative bacteria using the Kirby-Bauer disc diffusion method.
Methodology:
This was a cross-sectional study conducted at the Department of Microbiology, Combined Military Hospital, from 1st July to 31st December 2024. A total of 101 specimens submitted to the department and growing carbapenem-resistant gram-negative rods were included consecutively; duplicate specimens were excluded. Specimens—including urine, blood, pus, respiratory samples, and body fluids—were processed using conventional methods. Organisms were identified by colony morphology, microscopic features, biochemical tests, and API-10S. The Kirby-Bauer disc diffusion method was performed on Cation-Adjusted Mueller-Hinton agar plates according to CLSI guidelines. Cefiderocol disk diffusion was applied on both commercially prepared CAMH-agar plates and manually produced ID-CAMH-agar plates. Data were analyzed using SPSS version 23 with descriptive statistics and Fisher's exact test to assess Cefiderocol sensitivity across demographic strata.
Results:
The mean age of patients was 42.6 ± 14.3 years, with 55.4% males and 70.3% indoor cases. Pus (28.7%), urine (26.7%), and blood (23.8%) were the most common specimen types. Enterobacterales (66.3%) and Pseudomonas aeruginosa (21.8%) were frequently isolated. Cefiderocol sensitivity was observed in 77.2% of isolates, while resistance was noted in 17.8%.
Conclusions:
Cefiderocol demonstrates a high level of activity against carbapenem-resistant gram-negative microorganisms, supporting its clinical utility in effectively managing severe and complex infections. These findings highlight Cefiderocol as a promising therapeutic option.
Article Details
Work published in JPMI is licensed under a
Creative Commons Attribution-NonCommercial 2.0 Generic License.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
1. Nordmann P, Poirel L. Epidemiology and diagnostics of carbapenem resistance in gram-negative bacteria. Clin Infect Dis 2019;69(Suppl 7):S521–528.
2. Tompkins K, van Duin D. Treatment for carbapenem-resistant Enterobacterales infections: recent advances and future directions. Eur J Clin Microbiol Infect Dis 2021;40(10):2053–2068.
3. Morris CP, Bergman Y, Tekle T, Fissel JA, Tamma PD, Simner PJ. Cefiderocol antimicrobial susceptibility testing against multidrug-resistant gram-negative bacilli: a comparison of disk diffusion to broth microdilution. J Clin Microbiol 2021;59(1):e01649-20.
4. Kolesnik-Goldmann N, Barbazon Seth-Smith HM, Haldimann K, Imkamp F, Roloff T, Zbinden R, et al. Comparison of disk diffusion, E-test, and broth microdilution methods for testing in vitro activity of cefiderocol in Acinetobacter baumannii. Antibiotics (Basel) 2023;12(7):1212–1215.
5. Giacobbe DR, Ciacco E, Girmenia C, Pea F, Rossolini GM, Sotgiu G, et al. Evaluating cefiderocol in the treatment of multidrug-resistant gram-negative bacilli: a review of the emerging data. Infect Drug Resist 2020;13:4697–4711.
6. Karakonstantis S, Rousaki M, Kritsotakis EI. Cefiderocol: systematic review of mechanisms of resistance, heteroresistance and in vivo emergence of resistance. Antibiotics (Basel) 2022;11(6):723.
7. Morris CP, Bergman Y, Tekle T, Fissel JA, Tamma PD, Simner PJ. Cefiderocol antimicrobial susceptibility testing against multidrug-resistant gram-negative bacilli: a comparison of disk diffusion to broth microdilution. J Clin Microbiol 2020;59(1):e010-20.
8. Kohira N, Hackel MA, Ishioka Y, Kuroiwa M, Sahm DF, Sato T, et al. Reduced susceptibility mechanism to cefiderocol, a siderophore cephalosporin, among clinical isolates from a global surveillance programme (SIDERO-WT-2014). J Glob Antimicrob Resist 2020;22:738–741.
9. Malik S, Kaminski M, Landman D, Quale J. Cefiderocol resistance in Acinetobacter baumannii: roles of beta-lactamases, siderophore receptors, and penicillin-binding protein 3. Antimicrob Agents Chemother 2020;64(12):e01221-20.
10.Bianco G, Boattini M, Comini S, Banche G, Cavallo R, Costa C. Disc diffusion and COMASP cefiderocol microdilution panel to overcome the challenge of cefiderocol susceptibility testing in clinical laboratory routine. Antibiotics (Basel) 2023;12(3):604–612.
11. Piotrowski M, Alekseeva I, Arnet U, Yucel E. Insights into the rising threat of carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa epidemic infections in Eastern Europe: a systematic literature review. Antibiotics (Basel) 2024;13(10):978.
12. Wang Q, Wang X, Wang J, Ouyang P, Jin C, Wang R, et al. Phenotypic and genotypic characterization of carbapenem-resistant Enterobacteriaceae: data from a longitudinal large-scale CRE study in China (2012–2016). Clin Infect Dis 2018;67(Suppl 2):S196–S205.
13. Longshaw C, Manissero D, Tsuji M, Echols R, Yamano Y. In vitro activity of the siderophore cephalosporin, cefiderocol, against molecularly characterized, carbapenem-non-susceptible gram-negative bacteria from Europe. JAC Antimicrob Resist 2020;2(3):dlaa060.
14. Papadimitriou-Olivgeris M, Bartzavali C, Lambropoulou A, Solomou A, Tsiata E, Anastassiou ED, et al. Reversal of carbapenemase-producing Klebsiella pneumoniae epidemiology from blaKPC- to blaVIM-harbouring isolates in a Greek ICU after introduction of ceftazidime/avibactam. J Antimicrob Chemother 2019;74(7):2051–2054.
15. Jacobs MR, Abdelhamed AM, Good CE, Rhoads DD, Hujer KM, Hujer AM, et al. ARGONAUT-I: activity of cefiderocol (S-649266), a siderophore cephalosporin, against gram-negative bacteria, including carbapenem-resistant nonfermenters and Enterobacteriaceae with defined extended-spectrum beta-lactamases and carbapenemases. Antimicrob Agents Chemother 2019;63(1):e01801-18.
16. Falagas ME, Skalidis T, Vardakas KZ, Legakis NJ, Hellenic Cefiderocol Study Group. Activity of cefiderocol (S-649266) against carbapenem-resistant gram-negative bacteria collected from inpatients in Greek hospitals. J Antimicrob Chemother 2017;72(6):1704–1708.
17. Zhanel GG, Golden AR, Zelenitsky S, Wiebe K, Lawrence CK, Adam HJ, et al. Cefiderocol: a siderophore cephalosporin with activity against carbapenem-resistant and multidrug-resistant gram-negative bacilli. Drugs 2019;79(3):271–289.
18. Hackel MA, Tsuji M, Yamano Y, Echols R, Karlowsky JA, Sahm DF. In vitro activity of the siderophore cephalosporin, cefiderocol, against carbapenem-nonsusceptible and multidrug-resistant isolates of gram-negative bacilli collected worldwide in 2014 to 2016. Antimicrob Agents Chemother 2018;62(2):e01968-17.
19. Poirel L, Sadek M, Nordmann P. Contribution of PER-type and NDM-type beta-lactamases to cefiderocol resistance in Acinetobacter baumannii. Antimicrob Agents Chemother 2021;65(10):e010-21.
20. Cercenado E, Cardenoso L, Penin R, Longshaw C, Henriksen AS, Pascual A. In vitro activity of cefiderocol and comparators against isolates of gram-negative bacterial pathogens from a range of infection sources: SIDERO-WT-2014–2018 studies in Spain. J Glob Antimicrob Resist 2021;26:292–300.
21. Kazmierczak KM, Tsuji M, Wise MG, Hackel M, Yamano Y, Echols R, et al. In vitro activity of cefiderocol, a siderophore cephalosporin, against a recent collection of clinically relevant carbapenem-non-susceptible gram-negative bacilli, including serine carbapenemase- and metallo-beta-lactamase-producing isolates (SIDERO-WT-2014 Study). Int J Antimicrob Agents 2019;53(2):177–184.
22. Morris CP, Bergman Y, Tekle T, Fissel JA, Tamma PD, Simner PJ. Cefiderocol antimicrobial susceptibility testing against multidrug-resistant gram-negative bacilli: a comparison of disk diffusion to broth microdilution. J Clin Microbiol 2020;59(1):e010-20