In vitro efficacy of ceftazidime/avibactam and cefiderocol against multidrug-resistant Gram-negative uropathogens: insights into β-lactamase-mediated resistance in clinical isolates
Abstract
Abstract Background Urinary tract infections (UTIs) are among the most common bacterial infections in hospitalized patients, frequently caused by Gram-negative bacteria such as Escherichia coli , Klebsiella pneumoniae , Proteus mirabilis , and Pseudomonas aeruginosa . The increasing prevalence of multidrug-resistant (MDR) isolates, mainly those producing β-lactamases, presents a major therapeutic challenge. This study investigates the in vitro efficacy of ceftazidime–avibactam (CZA) and cefiderocol against MDR Gram-negative uropathogens. Methods A total of 110 Gram-negative uropathogens were included in this study. The isolates were re-identified using standard biochemical tests, and antimicrobial susceptibility was assessed via the disk diffusion method. Phenotypic and genotypic methods were performed to detect β-lactamase production in selected MDR isolates. Results Among the retrieved isolates, 89 (80.9%) were MDR. The highest MDR rates were observed in P. mirabilis (100%) and P. aeruginosa (91%), followed by K. pneumoniae (90%) and E. coli (66%). Most isolates showed high resistance to β-lactams, fluoroquinolones, and aminoglycosides. CZA showed variable activity, with the highest susceptibility in P. mirabilis (100%) and E. coli (68.1%), while resistance was significant in K. pneumoniae (83.3%) and P. aeruginosa (77.3%). Notably, cefiderocol exhibited strong in vitro activity against CZA- and carbapenem-resistant isolates, based on disk diffusion testing. Molecular…
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