European Journal of Clinical Microbiology & Infectious Diseases最新文献

{"title":"Genomic epidemiology of vancomycin-resistant Enterococcus faecium in Eastern Denmark from 2020 to 2022, and identification of vanB Tn1549 insertion sites.","authors":"Maja Johanne Søndergaard Knudsen, Jose Alfredo Samaniego Castruita, Ingrid Maria Cecilia Rubin, Sarah Mollerup, Helle Krogh Johansen, Rasmus L Marvig, Karen Leth Nielsen, Barbara Juliane Holzknecht, Morten Hoppe, Michael Kemp, Henrik Westh, Mette Pinholt","doi":"10.1007/s10096-025-05091-y","DOIUrl":"10.1007/s10096-025-05091-y","url":null,"abstract":"<p><strong>Background: </strong>We aimed to describe the genomic epidemiology of vancomycin-resistant Enterococcus faecium (VREfm) in Eastern Denmark from 2020 to 2022, identify and characterise the vanB Transposon 1549 (Tn1549) insertion sites among vanB VREfm clones and identify emerging VREfm clones.</p><p><strong>Methods: </strong>We analysed all VREfm from our routine diagnostic sequencing during the study period. Using the Seqsphere + v.8.2.0 software (Ridom GmbH, Münster, Germany, ( http://www.ridom.de/seqsphere ), minimum spanning trees were created to visualise clusters. Tn1549 insertion sites were determined by in silico PCR. Nanopore sequencing was performed to assemble the regions surrounding Tn1549, which helped determine the insertion site locations.</p><p><strong>Results: </strong>We included 2,437 isolates in the study. A total of 463 isolates carried vanA, 1,963 isolates carried vanB, and 11 isolates carried both genes. Of all isolates carrying vanB, 254 isolates had the Tn1549 inserted in the araA2 gene, 1,604 in the sir2 gene, and 116 in neither the araA2 nor sir2 genes. We identified eight chromosomal insertion sites other than in the araA2 and sir2 genes. Three isolates carried the Tn1549 on plasmids. No emerging clones were found.</p><p><strong>Results: </strong>We have described the genomic epidemiology during the study period and identified ten chromosomal Tn1549 insertion sites.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1425-1432"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Additional biomarkers and emm types associated with group A streptococcal toxic shock syndrome: a Japanese nationwide observational study.","authors":"Shigeo Hanada, Takeaki Wajima, Misako Takata, Miyuki Morozumi, Yukio Sato, Junichi Sasaki, Satoshi Iwata, Kimiko Ubukata","doi":"10.1007/s10096-025-05116-6","DOIUrl":"10.1007/s10096-025-05116-6","url":null,"abstract":"<p><strong>Purpose: </strong>The incidence of invasive Group A Streptococcus (iGAS) infection and streptococcal toxic shock syndrome (STSS) is increasing. Early detection and diagnosis of cases that may progress to STSS are currently difficult. In this study, we aimed to identify biomarkers and emm type, one of the virulence factors, associated with STSS development.</p><p><strong>Methods: </strong>In this multicentre observational study including patients with iGAS infection (n = 305), we investigated the relative associations of host factors, clinical manifestations, biomarkers, and emm type with STSS.</p><p><strong>Results: </strong>The overall mortality rate was 15.4%; the fatality rate within 28 days of admission was higher in patients with STSS (67.9%, 38/56) than in those without (3.6%, 9/249). The most predominant type was emm1 (38%), detected in 73.2% of the patients with STSS. Risk factors for STSS identified by multivariable analysis included underlying kidney disease (odds ratio [OR], 10.7; 95% confidence interval [CI], 2.1-54.0, p = 0.004), bacteraemia without primary focus (OR, 3.6; 95% CI 1.2-11.1, p = 0.023), necrotizing fasciitis (OR, 8.7; 95% CI 2.6-29.4, p < 0.001), white blood cell count (WBC) < 4,000/µL (OR, 7.8; 95% CI 2.4-25.6, p = 0.001), serum creatine kinase (CK) ≥ 300 U/L (OR, 7.5; 95% CI 2.8-19.8, p < 0.001), and emm1 (OR, 5.2; 95% CI 2.0-13.4, p = 0.001).</p><p><strong>Conclusion: </strong>WBC < 4,000/µL and CK level ≥ 300 U/L on admission are additional relevant biomarkers for STSS prediction. The most predominant iGAS type, emm1, was significantly associated with STSS.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1471-1480"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salvage therapy of complicated Candida albicans spondylodiscitis with Rezafungin.","authors":"Nina Grasselli Kmet, Roberto Luzzati, Jacopo Monticelli, Stella Babich, Jacopo Conti, Stefano Di Bella","doi":"10.1007/s10096-025-05117-5","DOIUrl":"10.1007/s10096-025-05117-5","url":null,"abstract":"<p><p>Invasive fungal infections, particularly those caused by Candida species, represent an increasing cause of hospital-related morbidity and mortality. Most commonly Candida spp. is the causative agent of candidemia and invasive candidiasis. In this report we present a complex case of Candida albicans spondylodiscitis, successfully treated with rezafungin, a new echinocandin suitable for weekly outpatient administration. This case illustrates the first documented use of rezafungin in an outpatient setting for C. albicans spondylodiscitis, demonstrating its potential in managing complex fungal infections.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1523-1526"},"PeriodicalIF":3.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic yield of Xpert MTB/RIF, Xpert MTB/RIF Ultra, and Truenat MTB assays on non-pulmonary samples from suspected cases of extra-pulmonary tuberculosis (EPTB).","authors":"Anvita Gupta Malhotra, Leena Lokhande, Abhijit Pakhare, Payal Soni, Satya Prakash Vishwakarma, Anand Kumar Maurya, Jitendra Singh, Sarman Singh","doi":"10.1007/s10096-025-05177-7","DOIUrl":"https://doi.org/10.1007/s10096-025-05177-7","url":null,"abstract":"<p><strong>Background: </strong>Extrapulmonary tuberculosis (EPTB) poses a diagnostic challenge due to its paucibacillary nature and low diagnostic yield of traditional methods. Molecular diagnostic tools like Xpert MTB/RIF, Xpert MTB/RIF Ultra, and Truenat MTB offer promising alternatives for the rapid and higher detection rates for pulmonary TB samples. However, the yield of these newly introduced molecular tests on extra-pulmonary samples requires country-specific evaluation and comparative analysis.</p><p><strong>Methodology: </strong>This study evaluated the diagnostic performance of Xpert MTB/RIF, Xpert MTB/RIF Ultra, and Truenat MTB assays in detecting EPTB on 211 clinical specimens collected at a tertiary care centre of central India. The assays' sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPP) were compared against a composite reference standard.</p><p><strong>Results: </strong>Xpert MTB/RIF Ultra exhibited the highest sensitivity (50%) for EPTB detection, outperforming the standard GeneXpert MTB/RIF (29.4%) and Truenat MTB (35.3%), with comparable specificity across all three assays. Among the specimen types, pus samples demonstrated the highest (value) diagnostic yield. These findings highlight the superior diagnostic capabilities of Xpert MTB/RIF Ultra, particularly in paucibacillary cases.</p><p><strong>Conclusion: </strong>Xpert Ultra demonstrates superior sensitivity for EPTB detection compared to Xpert MTB/RIF and Truenat MTB, making it a promising tool to enhance diagnostic accuracy in paucibacillary TB. Its adoption as a standard diagnostic method could significantly improve EPTB management. These findings advocate for integrating advanced molecular diagnostics into routine tuberculosis workflows to reduce diagnostic delays and improve patient outcomes.</p><p><strong>Clinical trail number: </strong>Not applicable.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"β-lactam antibiotics vs vancomycin in treating methicillin-sensitive staphylococcus aureus bloodstream infections: a meta-analysis of clinical outcomes.","authors":"Guoliang Yu, Yonghai Lou, Lingfang He, Zhitao Wang, Yu Ren","doi":"10.1007/s10096-025-05164-y","DOIUrl":"https://doi.org/10.1007/s10096-025-05164-y","url":null,"abstract":"<p><strong>Background: </strong>This meta-analysis systematically reviews and compares the efficacy of β-lactam antibiotics and vancomycin in the treatment of methicillin-sensitive Staphylococcus aureus (MSSA) bloodstream infections, with the aim of providing evidence-based recommendations for clinical decision-making.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed the PRISMA 2020 guidelines and was registered with PROSPERO. Two independent reviewers conducted comprehensive literature searches across multiple databases, specifically targeting Randomized Controlled Trial (RCT) and non-RCT comparing β-lactam antibiotics and vancomycin in treating MSSA bloodstream infections. Outcomes analyzed included mortality within 30 days and 90 days, defervescence time, bacterial clearance time, and treatment duration.</p><p><strong>Results: </strong>Seven retrospective cohort studies involving a total of 6957 patients were included. The pooled results indicated no significant difference in 30-day and 90-day mortality or treatment duration between the two antibiotics regimens. However, β-lactam antibiotics demonstrated a faster action, with significantly shorter times for fever reduction and bacterial clearance compared to vancomycin.</p><p><strong>Conclusions: </strong>This study found that β-lactam antibiotics are more efficacious than vancomycin in treating MSSA bloodstream infections. Although clinical outcomes such as mortality and treatment duration were similar between the groups, the faster clinical response observed with β-lactam antibiotics supports their preferential use in cases of MSSA infection. Since all included studies were retrospective, the overall reliability of the evidence is affected. Future high-quality prospective studies are needed to further validate these findings.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staphylococcus aureus vertebral osteomyelitis: a single-centre retrospective cohort study with focus on oral flucloxacillin follow-up.","authors":"Johan Wern, Bo Söderquist, Staffan Tevell","doi":"10.1007/s10096-025-05176-8","DOIUrl":"https://doi.org/10.1007/s10096-025-05176-8","url":null,"abstract":"<p><strong>Background: </strong>International guidelines for Staphylococcus aureus vertebral osteomyelitis recommend 6 weeks of treatment, including oral follow-up using antibiotics with high bioavailability such as a fluoroquinolone/rifampicin combination. Oral flucloxacillin is not recommended due to low bioavailability and scarce evidence. However, flucloxacillin as oral follow-up treatment is common practice in Sweden based on favourable clinical experience, good tolerability, few interactions, and low ecological impact. Our aim was to review a single-centre experience of S. aureus vertebral osteomyelitis, with focus on flucloxacillin treatment.</p><p><strong>Methods: </strong>A single-centre retrospective cohort of patients with Staphylococcus aureus vertebral osteomyelitis (n = 40) was identified between 2010 and 2016. Patients were further stratified by antibiotic treatment strategy with focus on oral flucloxacillin therapy (n = 24). Primary outcomes were relapse or death within 12 months of treatment initiation, and antibiotic-related adverse effects during treatment.</p><p><strong>Results: </strong>Methicillin-susceptible S. aureus (MSSA) caused 38 of the infections (95%), and five patients (13%) died, all in-hospital. Flucloxacillin was used for at least 75% of the oral treatment duration in 24 patients (60%). Median antibiotic treatment duration among these patients was 125.5 days (IQR 95-182), 109 days (IQR 76-149) of which comprised oral antibiotics. There were two relapses and two deaths among the patients treated predominantly with flucloxacillin, resulting in a composite clinical cure rate of 83% (20 of 24).</p><p><strong>Conclusions: </strong>Prolonged oral flucloxacillin administration could be a potential treatment option for MSSA vertebral osteomyelitis. A prospective study of optimal treatment duration and dosing strategies for flucloxacillin in vertebral osteomyelitis is warranted.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resurgence and seasonal patterns of RSV-B during the COVID-19 era: an 18-year retrospective hospital-based study.","authors":"Jeong Su Han, Hyeong Ho Kim, Jae-Sik Jeon, Jae Kyung Kim","doi":"10.1007/s10096-025-05178-6","DOIUrl":"https://doi.org/10.1007/s10096-025-05178-6","url":null,"abstract":"<p><p>Respiratory syncytial virus (RSV) is a leading cause of severe respiratory infections, particularly in infants, older adults, and immunocompromised individuals. In this study, we aimed to characterize the epidemiology of RSV subtype B (RSV-B), which remains relatively understudied compared with subtype A despite its clinical significance. We conducted a retrospective analysis of laboratory-confirmed RSV-B infections over 18 years (2007-2024) at a tertiary hospital in South Korea. The dataset included 23,284 cases analyzed for age distribution, seasonality, sex differences, and the impact of the coronavirus disease 2019 (COVID-19) pandemic. The highest positivity rate was observed in infants under 1 year (12.7%, p < 0.001), followed by ages 1-19 years (6.9%). RSV-B incidence peaked in winter (11.9%) and autumn (8.7%), with significant seasonal variation (p < 0.001). No statistically significant sex-based difference was observed (male: 6.1%, female: 6.7%; p = 0.102). Positivity rates declined markedly during the COVID-19 pandemic (2019-2022), likely due to non-pharmaceutical interventions. These findings clarify RSV-B's distinct epidemiology and underscore the need for subtype-specific surveillance, targeted vaccination, and adaptable public health strategies. This study provides evidence to improve outbreak prediction, identify high-risk groups, and optimize clinical and preventive responses to RSV-B.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial activity of lefamulin against pathogens most commonly causing community-acquired pneumonia: results from the China antimicrobial surveillance network in 2020-2022.","authors":"Li Ding, Siquan Shen, Renru Han, Dandan Yin, Yang Yang, Shi Wu, Demei Zhu, Yan Guo, Fupin Hu","doi":"10.1007/s10096-025-05175-9","DOIUrl":"https://doi.org/10.1007/s10096-025-05175-9","url":null,"abstract":"<p><strong>Objectives: </strong>Lefamulin is a novel pleuromutilin antibiotic used for the treatment of community-acquired pneumonia (CAP). This study aimed to evaluate the in vitro antimicrobial activity of lefamulin against clinical isolates obtained from China.</p><p><strong>Methods: </strong>1,052 non-duplicate isolates included the following isolates: Streptococcus pneumoniae (n = 529), Staphylococcus aureus (n = 306), Haemophilus influenzae (n = 121), Moraxella catarrhalis (n = 81), and Mycoplasma pneumoniae (n = 15), were collected from 70 hospitals participating in the China Antimicrobial Surveillance Network (CHINET) between October 1, 2020, and November 30, 2022. Minimum inhibitory concentrations were determined using the broth microdilution method in accordance with the standards set by the Clinical and Laboratory Standards Institute.</p><p><strong>Results: </strong>In vitro, S. pneumoniae exhibited 100% sensitivity to lefamulin, with MIC₉₀ values of 0.125 µg/mL for penicillin-susceptible strains, 0.25 µg/mL for penicillin-intermediate strains, and 0.125 µg/mL for penicillin-resistant strains. Lefamulin remained effective against S. pneumoniae strains resistant to penicillin, erythromycin, and azithromycin. The susceptibility rate of S. aureus to lefamulin was 97.7%, with methicillin-sensitive S. aureus showing 98.4% sensitivity and methicillin-resistant S. aureus showing 96.6% sensitivity. Both strains had MIC₉₀ values of 0.125 µg/mL. H. influenzae and M. catarrhalis demonstrated 100% sensitivity to lefamulin. The MIC of lefamulin against M. pneumoniae was ≤ 0.03 µg/mL.</p><p><strong>Conclusions: </strong>Lefamulin exhibited potent in vitro activity against prevalent and drug-resistant pathogens associated with CAP in China.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors associated with long-term shedding infections of non-typhoidal Salmonella in humans.","authors":"Andreas Rohringer, Lamprini Veneti, Anke Stüken, Elburg van Boetzelaer, Hilde M Lund, Zuzana Nordeng, Emily MacDonald, Umaer Naseer","doi":"10.1007/s10096-025-05165-x","DOIUrl":"https://doi.org/10.1007/s10096-025-05165-x","url":null,"abstract":"<p><strong>Purpose: </strong>Non-typhoidal Salmonella (NTS) gastroenteritis in humans is typically self-limited, resolving within 48-72 h. However, some infections result in a carrier state characterised by persistent gut colonisation and long-term shedding (LTS). This study aimed to investigate risk factors associated with LTS of NTS in humans.</p><p><strong>Methods: </strong>Salmonellosis cases reported to the Norwegian surveillance system in 2019 were invited to participate. Participants submitted a follow-up stool sample and a questionnaire five weeks after initial sampling (detecting infection). Stool samples were cultured, and isolates were sequenced to determine genotype, serotype and antimicrobial resistance genotype. NTS cases were classified as LTS if the isolates from both samples differed by ≤ 5 alleles. Adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs) were calculated using logistic regression to investigate potential risk factors associated with LTS.</p><p><strong>Results: </strong>Of 1,094 reported cases, 255 (23%) with NTS participated; 24% were classified as LTS. Children aged 0-5 years were 6.7 times more likely to exhibit LTS compared to adults aged 18-44 years (aOR = 6.71, 95%CI:1.67-26.94). Participants who received regular medication and those following a lactose-free diet were 2.2 (aOR = 2.17, 95%CI:1.02-4.64) and 7.2 (aOR = 7.24, 95%CI:1.48-35.40) times more likely to exhibit LTS than those who did not, respectively. Participants with S. Agbeni or S. Bron were 6 times more likely to exhibit LTS compared to S. Typhimurium cases (aOR = 6.29, 95%CI:1.40-28.16).</p><p><strong>Conclusions: </strong>Observed risk factors associated with LTS included young age, regular medication use, lactose-free diet, and specific Salmonella serotypes. Further research is needed to increase knowledge regarding LTS and inform infection control measures.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined resistance mechanisms leading to high-level of cefiderocol resistance among NDM-like producing E. coli ST167 clinical isolates.","authors":"Mustafa Sadek, Juan Bosch Duran, Trinad Chakraborty, Laurent Poirel, Patrice Nordmann","doi":"10.1007/s10096-025-05166-w","DOIUrl":"https://doi.org/10.1007/s10096-025-05166-w","url":null,"abstract":"<p><strong>Purpose: </strong>A series of NDM-producing Escherichia coli ST167 clinical isolates exhibiting resistance to cefiderocol (FDC), with no previous exposure to this antibiotic, were analyzed in this study.</p><p><strong>Methods: </strong>The antimicrobial susceptibility testing and phenotypic detection of resistance patterns (Rapid Cefiderocol NP test and MIC determination) were performed for all tested isolates. Their entire genomes were sequenced by using the Illumina MiSeq platform and high-quality reads were de-novo assembled using the CLC Genomic Workbench. Genome-sequence based characteristics were analyzed using bioinformatics tools.</p><p><strong>Results: </strong>All NDM-producing E. coli ST167 isolates showed a high level of resistance to FDC (MICs being 64 or > 64 mg/L). The chromosomally located cirA gene, encoding a catecholate siderophore receptor in E. coli, was truncated in all FDC-resistant isolates due to a frameshift mutation (S90Y), leading to CirA-deficient isolates. A four amino acid insertion (YRIN) was also identified after residue 333 in the PBP3 protein sequence of all E. coli isolates. Among them, a single FDC-resistant NDM-5-producing E. coli isolate (1006) was additionally resistant to aztreonam/avibactam (AZA MIC of 8 mg/L). When analyzed against the genome of another FDC resistant NDM-5 producing E. coli ST167 containing a YRIN insertion in the PBP3, and exhibiting decreased susceptibility to AZA, the broad-spectrum ß-lactamase CMY-42 was identified.</p><p><strong>Conclusion: </strong>We identified a variety of NDM-producing E. coli isolates exhibiting high level of resistance to FDC as a result of the combined effect of CirA deficiency, along with production of NDM-type enzymes. The spread of such resistance phenotype across Europe poses great concern on the clinical efficacy of this novel drug. Additionally, the identification of an FDC- and AZA-resistant NDM-5 producing E. coli isolate represents one of the ultimate evolutions with a possible step towards pan-resistance.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}