{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:59:33Z","timestamp":1792004373779,"version":"4.4.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["K24 AI121296"],"award-info":[{"award-number":["K24 AI121296"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01 AI148342"],"award-info":[{"award-number":["R01 AI148342"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01 AI134637"],"award-info":[{"award-number":["R01 AI134637"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["P01 AI152999"],"award-info":[{"award-number":["P01 AI152999"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01 AI175699"],"award-info":[{"award-number":["R01 AI175699"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R21 AI175821"],"award-info":[{"award-number":["R21 AI175821"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R21 AI190338"],"award-info":[{"award-number":["R21 AI190338"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Infections due to antimicrobial-resistant Gram-negative organisms present increasingly difficult therapeutic challenges, especially in the presence of metallo-\u03b2-lactamases. We present the case of a patient with cholangitis due to Pseudomonas aeruginosa and Klebsiella pneumoniae isolates that developed cefiderocol resistance on therapy treated successfully with cefepime-zidebactam.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Serial clinical isolates recovered from biliary fluid and ascitic fluid were tested for susceptibility to cefiderocol, aztreonam-avibactam, cefepime-taniborbactam, cefepime-zidebactam, and cefiderocol-xeruborbactam by broth microdilution. Whole-genome sequencing was performed to identify resistance determinants. An emergency investigational new drug application was authorized by the United States Food and Drug Administration for the compassionate use of cefepime-zidebactam based on susceptibility test results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Index isolates of P. aeruginosa (IMP positive) and K. pneumoniae (NDM-5, OXA-232 positive) tested susceptible to cefiderocol by disk diffusion in the clinical microbiology laboratory. The patient was treated with a regimen of cefiderocol and eravacycline, with persistent fever and development of hepatic microabscesses on imaging. Compassionate use cefepime-zidebactam therapy was initiated the day prior to liver transplantation and continued for a total of 14\u2005days due to positive ascitic fluid cultures obtained during the operation. The K. pneumoniae and P. aeruginosa were cefiderocol resistant by broth microdilution. Cefepime-zidebactam remained active with MICs of 8\/8\u2005mg\/L and 32\/32\u2005mg\/L, respectively. The patient did well post-transplant and resumed chemotherapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Antimicrobial therapy with cefepime-zidebactam along with source control allowed successful liver transplantation in a patient with cefiderocol-resistant K. pneumoniae and P. aeruginosa. Cefepime-zidebactam may be a therapeutic option for extensively drug-resistant Gram-negative organisms.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jacamr\/dlaf129","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T08:37:42Z","timestamp":1752741462000},"source":"Crossref","is-referenced-by-count":14,"title":["Cefepime-zidebactam therapy for extensively drug-resistant <i>Pseudomonas aeruginosa<\/i> and <i>Klebsiella pneumoniae<\/i> infection as a bridge to liver transplantation"],"prefix":"10.1093","volume":"7","author":[{"given":"Shemual","family":"Tsai","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Houston Methodist Hospital , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Nigo","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Center for Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute , Houston, TX ,","place":["USA"]},{"name":"Department of Medicine, Weill-Cornell Medical College , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5314-0961","authenticated-orcid":false,"given":"Donghoon","family":"Kang","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Center for Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo P","family":"Baptista","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Center for Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute , Houston, TX ,","place":["USA"]},{"name":"Department of Medicine, Weill-Cornell Medical College , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4143-6324","authenticated-orcid":false,"given":"Pranita D","family":"Tamma","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yehudit","family":"Bergman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"3rd","given":"David W","family":"Victor","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill-Cornell Medical College , New York, NY ,","place":["USA"]},{"name":"Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr Transplant Center, Houston Methodist Hospital , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashton A","family":"Connor","sequence":"additional","affiliation":[{"name":"Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr Transplant Center, Houston Methodist Hospital , Houston, TX ,","place":["USA"]},{"name":"Department of Surgery, Houston Methodist Hospital , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Saharia","sequence":"additional","affiliation":[{"name":"Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr Transplant Center, Houston Methodist Hospital , Houston, TX ,","place":["USA"]},{"name":"Department of Surgery, Houston Methodist Hospital , Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R Mark","family":"Ghobrial","sequence":"additional","affiliation":[{"name":"Sherrie and Alan Conover Center for Liver Disease and Transplantation, JC Walter Jr Transplant Center, Houston Methodist Hospital , Houston, TX ,","place":["USA"]},{"name":"Department of Surgery, Houston Methodist Hospital , Houston, TX ,","place":["USA"]},{"name":"Department of Surgery, Weill Cornell Medical College , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesar A","family":"Arias","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Center for Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute , Houston, TX ,","place":["USA"]},{"name":"Department of Medicine, Weill-Cornell Medical College , New York, NY 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