{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T00:15:23Z","timestamp":1793060123519,"version":"4.5.0"},"reference-count":60,"publisher":"American Society for Microbiology","issue":"11","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,11,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Cefiderocol and the \u03b2-lactam\/\u03b2-lactamase inhibitor (BL-BLI) combinations ceftazidime-avibactam (CAZ-AVI), imipenem-relebactam (IMI-REL), and ceftolozane-tazobactam (TOL-TAZ) are recommended for the treatment of difficult-to-treat resistance (DTR)\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      by IDSA guidelines. The activity of cefiderocol and the three BL-BLI combinations described above was examined against DTR\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      and molecularly characterized subsets collected from the USA and Europe (2020\u20132023). Approximately 4% of isolates showed a DTR phenotype, and cefiderocol remained active against 98.1% (CLSI breakpoint) of these isolates, whereas the three BL-BLI combinations had susceptibilities of 52.3%\u201356.0%. A total of 63% of DTR isolates were nonsusceptible to \u22651 of these BL-BLI combinations, and cefiderocol was active against \u226595.5% (CLSI) of these isolates, regardless of the nonsusceptible phenotype(s) to these combinations. In contrast, susceptibilities of the BL-BLI combinations varied from 0.0% to 30.3%. Almost 20% of DTR isolates carried carbapenemases, mostly metallo-\u03b2-lactamases, represented by 14 different STs from 15 countries. Cefiderocol had MIC\n                      <jats:sub>50\/90<\/jats:sub>\n                      of 0.25\/2 mg\/L against these carbapenemase-carrying DTR isolates and 97.3% (CLSI) of the isolates were susceptible to cefiderocol, whereas &lt;6% of these isolates were susceptible to any of the BL-BLI combinations. MIC\n                      <jats:sub>50\/90<\/jats:sub>\n                      of cefiderocol against the non-carbapenemase DTR subset was 0.12\/1 mg\/L, and 98.3% (CLSI) of the isolates were susceptible to cefiderocol, vs 63.7%\u201369.6% for the BL-BLI combinations. Cefiderocol demonstrated high activity against a large and contemporary collection of DTR\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      , regardless of carbapenemase status. The three currently recommended BL-BLI combinations for treating certain\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      infections demonstrated limited activity and high degree of cross-resistance.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        Cefiderocol and the \u03b2-lactam\/\u03b2-lactamase inhibitor (BL-BLI) combinations ceftazidime-avibactam (CAZ-AVI), imipenem-relebactam (IMI-REL), and ceftolozane-tazobactam (TOL-TAZ) are recommended for the treatment of difficult-to-treat resistance (DTR)\n                        <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                        by IDSA guidelines. However, this study shows that cefiderocol demonstrated high activity against a large collection of\n                        <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                        , including DTR isolates. In contrast, the three currently recommended BL-BLI combinations had limited activity, especially against isolates carrying carbapenemase genes, and high degree of cross-resistance. Cefiderocol also sustained activity against a diverse array of isolates with various BL-BLI nonsusceptible phenotypes, and regardless of carbapenemase status. These findings support the use of cefiderocol as a first treatment option for infections caused by DTR\n                        <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                        .\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.02079-25","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T12:00:41Z","timestamp":1760356841000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":16,"title":["Activity of cefiderocol against\n                    <i>Pseudomonas aeruginosa<\/i>\n                    from the USA and Europe (2020\u20132023) with difficult-to-treat resistance phenotype, including those nonsusceptible to recently developed \u03b2-lactam\/\u03b2-lactamase inhibitor combinations: results from the SENTRY antimicrobial surveillance program"],"prefix":"10.1128","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0457-1543","authenticated-orcid":true,"given":"John H.","family":"Kimbrough","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02qv6pw23","id-type":"ROR","asserted-by":"publisher"}],"name":"Element Iowa City (JMI Laboratories)","place":["North Liberty, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maura H.","family":"Karr","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02qv6pw23","id-type":"ROR","asserted-by":"publisher"}],"name":"Element Iowa City (JMI Laboratories)","place":["North Liberty, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Shionogi Inc.","place":["Florham Park, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8647-6274","authenticated-orcid":true,"given":"Boudewijn L. M.","family":"DeJonge","sequence":"additional","affiliation":[{"name":"Shionogi Inc.","place":["Florham Park, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5586-7256","authenticated-orcid":true,"given":"Chris","family":"Longshaw","sequence":"additional","affiliation":[{"name":"Shionogi B.V.","place":["London, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1949-5555","authenticated-orcid":true,"given":"Miki","family":"Takemura","sequence":"additional","affiliation":[{"name":"Shionogi & Co., Ltd.","place":["Osaka, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Yamano","sequence":"additional","affiliation":[{"name":"Shionogi & Co., Ltd.","place":["Osaka, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0126-1782","authenticated-orcid":true,"given":"Mariana","family":"Castanheira","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02qv6pw23","id-type":"ROR","asserted-by":"publisher"}],"name":"Element Iowa City (JMI Laboratories)","place":["North Liberty, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8648-1137","authenticated-orcid":true,"given":"Rodrigo E.","family":"Mendes","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02qv6pw23","id-type":"ROR","asserted-by":"publisher"}],"name":"Element Iowa City (JMI Laboratories)","place":["North Liberty, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1080\/14787210.2022.2071701"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00825-15"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/aac.01409-22"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.02700-22"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1128\/msystems.00524-19"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkz243"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.43.5.1301"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00574-09"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00031-19"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12866-016-0719-2"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2022.07.021"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms9020359"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-023-04697-4"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2021.765113"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkab496"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae403"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2020.106196"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000966"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01454-17"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01405-16"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlaa060"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.02712-21"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkac241"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dky317"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlae015"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1128\/spectrum.03108-23"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkad298"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-021-04308-0"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/jacamr\/dlad080"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac097"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkaa206"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.03681-14"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkx424"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02462-13"},{"key":"e_1_3_4_36_2","volume-title":"M07Ed12Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically","author":"CLSI","year":"2024","unstructured":"CLSI. 2024. 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