Rapid Development of Cefiderocol Resistance in Carbapenem-resistant Enterobacter cloacae During Therapy Is Associated With Heterogeneous Mutations in the Catecholate Siderophore Receptor cirA.

Sabrina Klein, Sébastien Boutin, Kaan Kocer, Mascha O. Fiedler, Dominic Störzinger, Markus A. Weigand, Benjamin Tan, Daniel Richter, Christian Rupp, Markus Mieth, Arianeb Mehrabi, Thilo Hackert, Stefan Zimmermann, Klaus Heeg, Dennis Nurjadi


We report a case of resistance development toward cefiderocol in a patient with intra-abdominal and bloodstream infections caused by carbapenemase-producing Enterobacter cloacae within 21 days of cefiderocol therapy. Whole genome sequencing revealed heterogeneous mutations in the cirA gene, encoding a catecholate siderophore receptor, conferring phenotypic resistance to cefiderocol.
Original languageEnglish
JournalClin Infect Dis
Issue number5
Publication statusPublished - 01.03.2022

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