Optimizing target inactivation to treat multidrug-resistant Escherichia coli with NDM and PBP3 mutations: “going the extra mile”
Open Access
- 6 May 2026
- journal article
- Published by American Society for Microbiology in Antimicrobial Agents and Chemotherapy
- Vol. 70 (5) , e0088725
Abstract
A 65-year-old man without identifiable risk factors for multidrug-resistant pathogens was admitted with peritonitis, isolating NDM-producing Escherichia coli from a rectal swab and intraoperative samples. After surgery, ceftazidime-avibactam/aztreonam was administered. Due to poor clinical response, he was switched to imipenem-relebactam/aztreonam, resulting in a successful outcome. Whole-genome sequencing detected bla NDM-5 and bla CMY-148 β-lactamases, PBP3 YRIN insertion, and mutated cirA gene. This case illustrates the importance of considering different mechanisms of resistance when choosing combination therapy.Keywords
This publication has 19 references indexed in Scilit:
- In vitro antimicrobial activity of six novel β-lactam and β-lactamase inhibitor combinations and cefiderocol against NDM-producing Enterobacterales in ChinaInternational Journal of Antimicrobial Agents, 2024
- Activity of aztreonam-avibactam against Enterobacterales resistant to recently approved beta-lactamase inhibitor combinations collected in Europe, Latin America, and the Asia-Pacific Region (2020–2022)International Journal of Antimicrobial Agents, 2024
- Next generation antibiotic combinations to combat pan-drug resistant Klebsiella pneumoniaeScientific Reports, 2024
- Novel CMY-186 variant conferring cross-resistance to cefiderocol and ceftazidime/avibactam in Klebsiella pneumoniae from a critically ill patient during cefiderocol and ceftazidime/avibactam treatmentInternational Journal of Antimicrobial Agents, 2024
- 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 InfectionClinical Infectious Diseases, 2024
- An NDM-Producing Escherichia coli Clinical Isolate Exhibiting Resistance to Cefiderocol and the Combination of Ceftazidime-Avibactam and Aztreonam: Another Step Toward Pan-β-Lactam ResistanceOpen Forum Infectious Diseases, 2023
- β-Lactam Resistance in ESKAPE Pathogens Mediated Through Modifications in Penicillin-Binding Proteins: An OverviewInfectious Diseases and Therapy, 2023
- Escherichia coli strains possessing a four amino acid YRIN insertion in PBP3 identified as part of the SIDERO-WT-2014 surveillance studyJAC-Antimicrobial Resistance, 2020
- Dual β-lactam combination therapy for multi-drug resistant Pseudomonas aeruginosa infection: enhanced efficacy in vivo and comparison with monotherapies of penicillin-binding protein inhibitionScientific Reports, 2019
- Emergence of NDM-5-producing Escherichia coli sequence type 167 clone in ItalyInternational Journal of Antimicrobial Agents, 2018