Cefiderocol Microbiology Resource Center

A centralized hub for information on cefiderocol susceptibility testing and surveillance

Cefiderocol Susceptibility Data

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In vitro surveillance data consistently show that Gram-negative isolates collected in North America and Europe remain highly susceptible to cefiderocol, including isolates non-susceptible to β-lactam/β-lactamase inhibitor combinations, isolates that produce metallo-β-lactamases or other carbapenemases, and isolates defined as MDR, XDR, or DTR. This activity differentiates cefiderocol from other agents.1-6

Spectrum of Activity Table

Cefiderocol in vitro activity against select Gram-negative pathogens with prevalent resistance mechanisms:

In vitro* susceptibility data specific to resistant Gram-negative pathogens for antibiotics indicated for adult patients with cUTI and/or HABP/VABP since 2014

Enterobacterales P. aeruginosa A. baumannii S. maltophilia Other resistance mechanisms​
ESBLs and/or​ AmpC Serine​ carbapenemases​ Metallo-​β-lactamases​ Serine​ β-lactamases​ (including AmpC) Metallo-​β-lactamases​ Serine carbapenemases (OXA) and/or AmpC​ Intrinsic​ resistance due​ to L1 metallo-​β-lactamasea Porin channel​ mutations​ Efflux pump​ up-regulation​
Cefiderocol7
Ceftolozane/tazobactam8
Ceftazidime/avibactam9 + / –
Meropenem/vaborbactam10 + / – + / –
Plazomicin11 + / – + / –
Imipenem/cilastatin/​ relebactam12
Sulbactam/durlobactam13 b

This information should not be used to make efficacy or safety comparisons between or among mentioned products. Some products are also indicated for different pathogens and patient populations and may have additional indications.

✓ = Active; + / – = Limited Activity; Blank = Inactive, No Data​

*In vitro susceptibility does not necessarily correlate with clinical efficacy.​

aS. maltophilia produces an inducible L1 enzyme, a metallo-β-lactamase, conferring an intrinsic resistance to all carbapenems.14,15

bDoes not include AmpC.

cUTI=complicated urinary tract infection; ESBL=extended-spectrum β-lactamase; HABP=hospital-acquired bacterial pneumonia; OXA=oxacillinase; VABP=ventilator-associated bacterial pneumonia.

SENTRY Antimicrobial Surveillance Program

SENTRY is a multinational sentinel surveillance study initiated in 1997 by JMI Laboratories to longitudinally track antimicrobial resistance worldwide. Cefiderocol was first included as part of the SENTRY surveillance program in 2020 to monitor for cefiderocol resistance in North American and Europe. Since that time, more than 58,000 Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii-calcoaceticus complex, and Stenotrophomonas maltophilia isolates have been collected for analysis.

Cefiderocol In Vitro Susceptibility Based on Clinical Strains From SENTRY1
Activity of cefiderocol against Gram-negative pathogens collected from 2020 to 2024
Pathogen (n) MIC (µg/mL) CLSI (%)a FDA (%)a
MIC50 MIC90 MIC range S I R S I R
Enterobacterales (39,791) 0.06 0.5 ≤0.004 to >64 99.8 0.2 0.1 99.8 0.2 0.1
Carb-NS Enterobacterales (957) 1 4 0.008 to >64 95.1 3.4 1.5 95.1 3.4 1.5
Pseudomonas aeruginosa (11,709) 0.12 0.5 ≤0.004 to >64 99.7 0.1 0.2 98.4 0.8 0.7
Carb-NS P. aeruginosa (2065) 0.12 0.5 ≤0.004 to >64​ 98.6 0.5 0.9 94.8 2.6 2.6
ABC (4800) 0.12 1 ≤0.004 to >64​ 96.7 1.1 2.2 91.9 3.1 5.0
Carb-NS ABC (2215) 0.25 2 0.008 to >64​ 93.6 2.1 4.3 84.8 5.4 9.8
Stenotrophomonas maltophilia (2341) 0.06 0.25 ≤0.004 to >64 99.3 – – – – –
Achromobacter spp. (303) 0.03 0.25 ≤0.004 to 8 – – – – – –
Burkholderia spp. (269) 0.06 0.5 ≤0.004 to >64 – – – – – –

aCriteria as published by CLSI (2025) and FDA (2025). ​

ABC=Acinetobacter baumannii-calcoaceticus complex; Carb-NS=carbapenem non-susceptible; CLSI=Clinical and Laboratory Standards Institute; FDA=US Food and Drug Administration; I=intermediate; MIC=minimum inhibitory concentration; R=resistant; S=susceptible.

Selected SENTRY Publications
In Vitro Activity Assessment of Cefiderocol Against Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp., Including β-lactam Nonsusceptible Molecularly Characterized Isolates, Collected From 2020 to 2021 in the United States and European Hospitals

Kimbrough JH, Maher JM, Sader HS, Castanheira M, Mendes RE. Microbiol Spectr. 2024;12(11):e0147424.

Key Points

  • For Enterobacterales, 96.6% of carbapenem-NS isolates and 92.3% of MBL-containing isolates were susceptible to cefiderocol
  • For P. aeruginosa, 93.3% of cephalosporin/carbapenem-NS isolates and 98.6% of MDR isolates were susceptible to cefiderocol
  • For Acinetobacter spp., 97.3% of cephalosporin/carbapenem-NS isolates and 97.1% of MDR isolates were susceptible to cefiderocol

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In Vitro Activity of Cefiderocol Against U.S. and European Gram-Negative Clinical Isolates Collected in 2020 as Part of the SENTRY Antimicrobial Surveillance Program

Shortridge D, Streit JM, Mendes R, Castanheira M. Microbiol Spectr. 2022;10(2):e0271221.

Key Points

  • For Enterobacterales, 99.8% of all isolates and 98.2% of CRE isolates were susceptible to cefiderocol
  • For P. aeruginosa, 99.6% of all isolates and 97.3% of XDR isolates were susceptible to cefiderocol
  • For Acinetobacter spp., 97.7% of all isolates were susceptible to cefiderocol
  • For S. maltophilia, 100% of all isolates were susceptible to cefiderocol

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Additional Surveillance Data

SIDERO-WT In Vitro Surveillance Study (2014-2019)
In Vitro Susceptibility of Gram-Negative Pathogens to Cefiderocol in Five Consecutive Annual Multinational SIDERO-WT Surveillance Studies, 2014 to 2019

Karlowsky JA, Hackel MA, Takemura M, Yamano Y, Echols R, Sahm DF. Antimicrob Agents Chemother. 2022;66(2):e0199021.

Key Points

  • For Enterobacterales, 99.8% of all isolates and 96.7% of meropenem-NS isolates were susceptible to cefiderocol
  • For P. aeruginosa, 99.9% of all isolates and 99.8% of meropenem-NS isolates were susceptible to cefiderocol
  • For A. baumannii, 96.0% of all isolates and 94.2% of meropenem-NS isolates were susceptible to cefiderocol
  • For S. maltophilia, 98.6% of all isolates were susceptible to cefiderocol

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In Vitro Activity of Cefiderocol Against MBL-Producing Gram-Negative Bacteria Collected in North America and Europe in Five Consecutive Annual Multinational
SIDERO-WT Surveillance Studies (2014–2019)

Takemura M, Wise MG, Hackel MA, Sahm DF, Yamano Y. J Antimicrob Chemother. 2023;78(8):2019-2027.

Key Points

  • 91.5%, 100%, and 60.0% of MBL-producing Enterobacterales, P. aeruginosa, and A. baumannii complex isolates, respectively, were susceptible to cefiderocol
  • Cefiderocol was the most active antimicrobial tested against the MBL-producing isolates, when compared with other β-lactams and β-lactam/β-lactamase inhibitor combinations

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In Vitro Activity of Cefiderocol Against Meropenem-Nonsusceptible Gram-Negative Bacilli With Defined
β-Lactamase Carriage: SIDERO-WT Surveillance Studies, 2014–2019

Wise MG, Karlowsky JA, Hackel MA, et al. Microb Drug Resist. 2023;29(8):360-370.

Key Points

  • For Enterobacterales, 91.5% of MBL-producing, 98.4% of KPC-producing, 97.3% of OXA-48 group-producing, and 98.7% of carbapenemase-negative isolates were susceptible to cefiderocol
  • For P. aeruginosa, 100% of MBL-producing, 100% of GES
    carbapenemase-producing, and 99.8% of carbapenemase-negative isolates were susceptible to cefiderocol
  • For A. baumannii complex, 60.0% of MBL-producing, 95.6% of OXA-23
    group-producing, 89.5% of OXA-24 group-producing, 100% of OXA-58
    group-producing, and 95.5% of carbapenemase-negative isolates were susceptible to cefiderocol; cefiderocol was inactive against isolates carrying a PER or VEB

    β-lactamase (15.5% susceptible)

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Abbreviations: ABC=Acinetobacter baumannii-calcoaceticus complex; Carb-NS=carbapenem non-susceptible; CLSI=Clinical and Laboratory Standards Institute; CRE=carbapenem-resistant Enterobacterales; DTR=difficult-to-treat resistant; ESBL=extended-spectrum β-lactamase; FDA=US Food and Drug Administration; I=intermediate; MBL=metallo-β-lactamase; MDR=multidrug-resistant; MIC=minimum inhibitory concentration; NS=non-susceptible; OXA=oxacillinase; R=resistant; S=susceptible; XDR=extensively drug-resistant.

References:

  1. Shionogi Inc. Data on file. 2025.
  2. Kimbrough JH, et al. Microbiol Spectr. 2024;12(11):e0147424.
  3. Shortridge D, et al. Microbiol Spectr. 2022;10(2):e0271221.
  4. Karlowsky JA, et al. Antimicrob Agents Chemother. 2022;66(2):e0199021.
  5. Takemura M, et al. J Antimicrob Chemother. 2023;78(8):2019-2027.
  6. Wise MG, et al. Microb Drug Resist. 2023;29(8):360-370.
  7. Fetroja® [package insert]. Florham Park, NJ: Shionogi Inc.
  8. Zerbaxa® [package insert]. Rahway, NJ; Merck Sharp & Dohme LLC; 2022.
  9. Avycaz® [package insert]. North Chicago, IL; AbbVie, Inc.; 2025.
  10. Vabomere® [package insert]. Parsippany, NJ; Melinta Therapeutics, LLC; 2024.
  11. Zemdri® [package insert]. Warren, NJ; Cipla Therapeutics Inc.; 2023.
  12. RecarbrioTM [package insert]. Rahway, NJ; Merck Sharp & Dohme LLC; 2022.
  13. Xacduro® [package insert]. La Jolla Pharmaceutical Company; 2023.
  14. Ruppé É, Woerther P-L, Barbier F. Ann Intensive Care. 2015;5(1):1-15.
  15. Sánchez MB. Front Microbiol. 2015;6:1-7.