Cefiderocol Is Effective In Vitro Against Numerous Gram-Negative Species Isolated from Keratitis Patients

Background: To evaluate the potential of cefiderocol as a topical ophthalmic antibiotic by determining the susceptibility of keratitis isolates from an extensive panel of Gram-negative bacterial species to this siderophore-cephalosporin class antibiotic. Methods: Minimum Inhibitory Concentrations (MICs) of cefiderocol were determined by the broth dilution method using iron-depleted, cation-adjusted Mueller–Hinton broth. The following Gram-negative bacteria were included: Acinetobacter baumannii (n = 13), Achromobacter xylosoxidans (n = 14), Escherichia coli (n = 15), Klebsiella aerogenes (n = 14), Klebsiella pneumoniae (n = 13), Klebsiella oxytoca (n = 14), Moraxella spp. (n = 15), Proteus mirabilis (n = 13), Pseudomonas aeruginosa (n = 17), Serratia marcescens (n = 14) and Stenotrophomonas maltophilia (n = 12). MIC90 values were calculated for each of the species. Results: MIC90 values (µg/mL): A. baumannii (0.5), A. xylosoxidans (0.25), E. coli (0.5), K. aerogenes (1.0), K. oxytoca (0.5), K. pneumoniae (0.5), Moraxella spp. (0.5), P. mirabilis (0.25), P. aeruginosa (0.5), S. marcescens (0.5), and S. maltophilia (0.25). In total, 100% of the isolates were determined to be susceptible to cefiderocol in vitro except for A. xylosoxidans and Moraxella spp., for which there are no established breakpoints for cefiderocol. Conclusions: Cefiderocol demonstrated in vitro activity against the tested panel of Gram-negative keratitis isolates. The results of this study suggest cefiderocol may be useful for the treatment of keratitis caused by numerous Gram-negative pathogens. Further development of cefiderocol for the topical treatment of Gram-negative keratitis is indicated.