Sequential Treatment Failure With Aztreonam-Ceftazidime-Avibactam Followed by Cefiderocol Due to Preexisting and Acquired Mechanisms in a New Delhi Metallo-β-lactamase-Producing Escherichia coli Causing Fatal Bloodstream Infection

Fiona Senchyna; Kanagavel Murugesan; William Rotunno; Sruti S Nadimpalli; Stan Deresinski; Niaz Banaei

doi:10.1093/cid/ciad759

Sequential Treatment Failure With Aztreonam-Ceftazidime-Avibactam Followed by Cefiderocol Due to Preexisting and Acquired Mechanisms in a New Delhi Metallo-β-lactamase-Producing Escherichia coli Causing Fatal Bloodstream Infection

Clin Infect Dis. 2024 Jun 14;78(6):1425-1428. doi: 10.1093/cid/ciad759.

Authors

Fiona Senchyna¹, Kanagavel Murugesan¹, William Rotunno², Sruti S Nadimpalli³, Stan Deresinski⁴, Niaz Banaei^{1

2

4}

Affiliations

¹ Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
² Clinical Microbiology Laboratory, Stanford University Medical Center,Palo Alto, California, USA.
³ Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
⁴ Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.

PMID: 38289725
DOI: 10.1093/cid/ciad759

Abstract

We report a fatal case of New Delhi metallo-β-lactamase (NDM)-producing Escherichia coli in a bacteremic patient with sequential failure of aztreonam plus ceftazidime-avibactam followed by cefiderocol. Acquired resistance was documented phenotypically and mediated through preexisting and acquired mutations. This case highlights the need to rethink optimal treatment for NDM-producing organisms.

Keywords: New Delhi metallo-β-lactamase; avibactam; aztreonam; carbapenemase; cefiderocol.

Publication types

Case Reports

MeSH terms

Anti-Bacterial Agents* / administration & dosage
Anti-Bacterial Agents* / therapeutic use
Azabicyclo Compounds* / administration & dosage
Azabicyclo Compounds* / therapeutic use
Aztreonam* / administration & dosage
Aztreonam* / pharmacology
Aztreonam* / therapeutic use
Bacteremia* / drug therapy
Bacteremia* / microbiology
Cefiderocol*
Ceftazidime* / administration & dosage
Ceftazidime* / therapeutic use
Cephalosporins* / administration & dosage
Cephalosporins* / therapeutic use
Drug Combinations*
Drug Resistance, Multiple, Bacterial
Escherichia coli Infections* / drug therapy
Escherichia coli Infections* / microbiology
Escherichia coli* / drug effects
Escherichia coli* / enzymology
Escherichia coli* / genetics
Escherichia coli* / isolation & purification
Fatal Outcome
Humans
Male
Microbial Sensitivity Tests
Treatment Failure*
beta-Lactamases* / genetics
beta-Lactamases* / metabolism

Substances

Azabicyclo Compounds
beta-Lactamases
Aztreonam
avibactam, ceftazidime drug combination
Drug Combinations
Ceftazidime
Anti-Bacterial Agents
Cefiderocol
Cephalosporins
beta-lactamase NDM-1

Grants and funding

Stanford Department of Pathology