
The study explored cefiderocol resistance mechanisms in Klebsiella pneumoniae (KP), finding that carbapenemase genes (blaNDM, blaKPC) increased KP’s minimum inhibitory concentration (MIC) to cefiderocol, while blaOXA-48 had a minor effect. Strains combining pNDM with cirA mutations or pKPC with envZ mutations exhibited high cefiderocol resistance. In contrast, the enterobactin-deficient strain showed increased cefiderocol susceptibility. The findings highlight that carbapenemase expression alone does not induce full resistance; rather, resistance in KP typically involves mutations in siderophore uptake receptor genes and two-component system genes.
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