Scientific article
OA Policy
English

Relative inhibitory activities of taniborbactam and xeruborbactam against KPC variants conferring reduced susceptibility or resistance to ceftazidime/avibactam, cefiderocol, and cefepime/taniborbactam

First online date2026-09-30
Abstract

The emergence of KPC variants associated with ceftazidime/avibactam resistance may also compromise the activity of other recently developed β-lactams, including cefiderocol and cefepime/taniborbactam. Xeruborbactam is a boronic acid β-lactamase inhibitor with potent activity against serine- and metallo-β-lactamases and is currently under clinical development in combination with cefiderocol. We evaluated the in vitro activity of cefiderocol/xeruborbactam against a panel of clinical Klebsiella pneumoniae isolates and isogenic Escherichia coli transformants (including both wild-type and porin-deficient backgrounds) producing KPC variants. Xeruborbactam and taniborbactam activities were compared using ceftazidime, cefepime, and cefiderocol as reporter substrates. Inhibitory activity was analyzed by determining the IC₅₀ values for both inhibitors against KPC variants. Most clinical isolates producing KPC variants showed increased MIC values and substantial cross-resistance to ceftazidime/avibactam, cefiderocol, and cefepime/taniborbactam. Cefiderocol/xeruborbactam retained potent activity against all clinical isolates, regardless of the KPC variant produced or the outer membrane permeability status. These findings were confirmed in wild-type and porin-deficient isogenic E. coli models, in which the combination of KPC variants and porin loss synergistically increased resistance to multiple β-lactams, while cefiderocol/xeruborbactam consistently restored susceptibility to wild-type levels. Comparative MIC analyses showed that xeruborbactam enhanced the activity of all β-lactam partners to a greater extent than taniborbactam. IC₅₀ determinations revealed a 17-fold to 73-fold greater inhibitory potency of xeruborbactam, which was maintained across structurally diverse KPC variants. Overall, cefiderocol/xeruborbactam exhibited potent activity against KPC-producing Enterobacterales, including isolates producing KPC variants associated with reduced susceptibility or resistance to ceftazidime/avibactam, cefiderocol, and cefepime/taniborbactam.

Keywords
  • KPC
  • Klebsiella pneumoniae
  • Carbapenemase
  • Cefiderocol
  • Ceftazidime-avibactam
  • Taniborbactam
  • Xeruborbactam
  • Β-lactamase
  • Β-lactamase inhibitor
Funding
  • Instituto de Salud Carlos III [PI24/02026, CB21/13/00055]
  • Instituto de Salud Carlos III [PI25/00116, JR21/00026, PI22/01212]
  • Xunta de Galicia [IN606A 2024/022]
  • Xunta de Galicia [IN606A 2025/020]
  • Xunta de Galicia [IN607A 2024/09]
  • Xunta de Galicia [IN607D 2024/08]
  • Instituto de Salud Carlos III [CB21/13/00055, PI24/00920]
  • Instituto de Salud Carlos III [CM23/00104]
  • Instituto de Salud Carlos III [FI23/00074]
  • Instituto de Salud Carlos III [JR25/00031]
Citation (ISO format)
RODRÍGUEZ-PALLARES, Salud et al. Relative inhibitory activities of taniborbactam and xeruborbactam against KPC variants conferring reduced susceptibility or resistance to ceftazidime/avibactam, cefiderocol, and cefepime/taniborbactam. In: Antimicrobial agents and chemotherapy, 2026, p. e0089726. doi: 10.1128/aac.00897-26
Main files (1)
Article (Published version)
Identifiers
Additional URL for this publicationhttps://journals.asm.org/doi/10.1128/aac.00897-26
Journal ISSN0066-4804
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