Adapting Cefiderocol Testing Amid Rising AMR: Exploring Mycoviral Solutions

Amid a surge in multidrug-resistant Gram-negative infections, ensuring accurate cefiderocol susceptibility testing has become a clinical imperative, even as agricultural research explores mycoviral diversity to curb fungal resistance.

Cefiderocol’s novel siderophore mechanism offers a critical lifeline against pathogens such as Enterobacterales and Acinetobacter baumannii, yet its clinical uptake has been slowed by variability in laboratory testing. Recent real-world performance of susceptibility testing for cefiderocol reveals significant discordance across methods, with some laboratories reporting up to 15% categorical errors that could lead to suboptimal therapy.

Broth microdilution remains the reference standard, but its reliance on iron-depleted media and stringent procedural controls stretches microbiology workflows. A detailed evaluation confirmed that only specialized centers routinely meet these requirements, prompting many institutions to adopt disk diffusion despite its interpretive limitations.

Disk diffusion testing, while more accessible, can miss subtle resistance patterns in Pseudomonas aeruginosa and other Gram-negative organisms, occasionally delaying appropriate therapy adjustments. Some laboratories have begun layering dual-method algorithms, cross-referencing disk diffusion with modified microdilution breakpoints tailored to local resistance profiles.

Meanwhile, the diversity of mycoviruses is opening new vistas in resistance management beyond the hospital. A recent biocontrol perspective on mycoviruses outlines how viruses inducing hypovirulence in fungi like Botrytis cinerea could suppress crop pathogens and reduce fungicide dependence, slowing the evolution of resistant isolates.

Bridging these domains, infectious disease specialists and agricultural pathologists might collaborate on virus-guided strategies—whether adapting viral inhibitors to target clinical fungi or harnessing viral mechanisms for novel antimicrobials. Advancing cefiderocol testing protocols in parallel with mycoviral biocontrol research offers a holistic pathway to sustainable resistance management across human and plant health.

Key Takeaways:

• Cefiderocol’s efficacy against resistant Gram-negative infections hinges on reliable susceptibility testing amid methodological challenges.
• Broth microdilution delivers accuracy but demands iron-depleted media and specialized protocols; disk diffusion offers accessibility at the expense of precision.
• Mycoviral biocontrol represents an innovative agricultural strategy with potential to inform holistic antimicrobial resistance management.