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Cefiderocol: A Novel Agent for the Management of Multidrug-Resistant Gram-Negative Organisms
Open accessAbstract
Cefiderocol, formerly S-649266, is a first in its class, an injectable siderophore cephalosporin that combines a catechol-type siderophore and cephalosporin core with side chains similar to cefepime and ceftazidime. This structure and its unique mechanism of action confer enhanced stability against hydrolysis by many β-lactamases, including extended spectrum β-lactamases such as CTX-M, and carbapenemases such as KPC, NDM, VIM, IMP, OXA-23, OXA-48-like, OXA-51-like and OXA-58. Cefiderocol's spectrum of activity encompasses both lactose-fermenting and non-fermenting Gram-negative pathogens, including carbapenem-resistant Enterobacterales. Cefiderocol recently received US Food and Drug Administration approval for the treatment of complicated urinary tract infections, including pyelonephritis, and is currently being evaluated in phase III trials for nosocomial pneumonia and infections caused by carbapenem-resistant Gram-negative pathogens. The purpose of this article is to review existing data on the mechanism of action, microbiology, pharmacokinetics, pharmacodynamics, efficacy, and safety of cefiderocol to assist clinicians in determining its place in therapy.
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“Apart from binding their primary ligand, FeEnt, with high affinity, and its aposiderophore Ent with 100-200-fold lower affinity (38), KpnFepA_1658, KpnIroN, and KpnFepA_4984 showed different preferences for ferric catecholate complexes and siderophore antibiotics cefiderocol [FeFDC (40,41)] and FeMB-1 (42,43):”
From Siderophore-mediated iron acquisition by Klebsiella pneumoniae (2024) · cites this paper as [41]
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“The understanding of EcoFiu and its orthologs will aid the further development of siderophore antibiotics (Lasko and Nicolau, 2020; Morris et al., 2020; Wu et al., 2020; Mabayoje et al., 2021) such as FDC.”
BackgroundCefiderocol Dosing for Patients Receiving Continuous Renal Replacement Therapy
Wei, X., Naseer, S., Weinstein, E. A., Iarikov, D. E., Nambiar, S., Reynolds, K. S., & Jang, S. H. (2022) · Clinical Pharmacology & Therapeutics · doi:10.1002/cpt.2703 · Cited by 12
Loeuille, G., Vigneron, J., D’Huart, É., Charmillon, A., & Demoré, B. (2021) · European Journal of Hospital Pharmacy · doi:10.1136/ejhpharm-2021-002935 · Cited by 13
Rosé, L., Lai, L., & Byrne, D. D. (2022) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.2660 · Cited by 12
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First report of a blaNDM-producing extensively drug resistant Klebsiella pneumoniae ST437 in Italy
Ranieri, S. C., Fabbrizi, V., Amario, A. M. D., Frascella, M. G., Biase, V. D., Francesco, C. D., Sante, S. D., Berardis, L. D., Martinis, M. D., Partenza, M., et al. (2024) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2024.1426817 · Cited by 11
Comprehensive Insights into Cephalosporins: Spectrum, Generations, and Clinical Applications
Nayeem, A., Ankul Singh, S., Vellapandian, C., Singh, S., Elossaily, G. M., & Prajapati, B. G. (2024) · Current Drug Therapy · doi:10.2174/0115748855339119241204071146 · Cited by 11
Stevenson, D. R., Cherian, B. P., Kinzig, M., Sörgel, F., & Wareham, D. W. (2022) · Journal of Global Antimicrobial Resistance · doi:10.1016/j.jgar.2022.11.019 · Cited by 11
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Sandiford, S. K. (2023) · Expert Opinion on Drug Discovery · doi:10.1080/17460441.2023.2198701 · Cited by 11
Cefiderocol is Not Sequestered in an Ex Vivo Extracorporeal Membrane Oxygenation (ECMO) Circuit
Berry, A. V., Conelius, A., Gluck, J., Nicolau, D. P., & Kuti, J. L. (2023) · European Journal of Drug Metabolism and Pharmacokinetics · doi:10.1007/s13318-023-00840-w · Cited by 11
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Gourabi, M. J. R., Khanbabaei, B., Saki, Y. Y., Nikoo, A., Kargar, M., Hashemi, A., & Sharahi, J. Y. (2025) · Current Microbiology · doi:10.1007/s00284-025-04597-0 · Cited by 10
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Metadata
- Authors
- Wu, J. Y., Srinivas, P., & Pogue, J. M.
- Affiliations
- Cleveland Clinic (US)
- University of Michigan (US)
- Corresponding author
- Wu, Janet Y.
- Venue
- Infectious Diseases and Therapy
- Published
- 2020-02-18
- Volume
- 9
- Issue
- 1
- Pages
- 17-40
- ISSN
- 2193-6382 (ISSN-L)
- 2193-8229
- PMC
- PMC7054475
- OpenAlex
- W3008901682
- Cited by
- 195
- References
- 45
- Citations by year
- 2026: 25 · 2025: 25 · 2024: 25 · 2023: 37 · 2022: 36 · 2021: 28 · 2020: 18
- FWCI
- 2.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Infectious Diseases and Therapy (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Microbiology (medical) › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Pharmacology (medical) › Antibiotics Pharmacokinetics and Efficacy
- Health Sciences › Medicine › Urology › Urinary Tract Infections Management
- Keywords
- cefiderocol, siderophore cephalosporin, multidrug-resistant Gram-negative bacteria, carbapenem resistance, extended-spectrum beta-lactamase, carbapenemase, mechanism of action, pharmacokinetics, pharmacodynamics, complicated urinary tract infection, nosocomial pneumonia, Enterobacterales, drug safety and efficacy
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