Fosfomycin susceptibility among multidrug-resistant, extended-spectrum beta-lactamase-producing, carbapenem-resistant uropathogens

Abstract

Introduction:Urinary tract infection (UTI) is one of the most common infectious diseases. With the emergence of multidrug resistance (MDR), therapeutic options for treatment of UTIs are becoming limited. Fosfomycin has emerged as a novel oral therapeutic option with bactericidal activity against the MDR uropathogens. We evaluated the susceptibility pattern of uropathogens to this antibiotic.Methods:A prospective study was conducted for 6 months in a tertiary care hospital in Eastern India to evaluate whether the common uropathogens were susceptible to fosfomycin. Identification of organisms causing significant bacteriuria was done by conventional biochemical and VITEK 2 Compact System™. Antimicrobial susceptibility testing was performed against these pathogens by Kirby-Bauer disc diffusion method. Minimum inhibitory concentrations were measured for certain drugs by E-strips and VITEK 2 Compact System.Results:A total of 2229 urine samples were referred for culture during the study period, which yielded 356 significant bacterial isolates. Among these isolates, 64.78% were extended-spectrum beta-lactamases producers, 15.97% were carbapenem-resistant Enterobacteriaceae, and 42.7% isolates were found to be MDR Enterobacteriaceae (MDRE). However, 95.18% of the total isolates and 95.93% of MDRE were found to be susceptible to fosfomycin.Conclusion:The common uropathogens, including MDR isolates, show high in vitro susceptibility to fosfomycin, which therefore has the potential to emerge as a promising alternative oral agent for outpatient therapy of UTIs.

Antibiotic susceptibility profile and extended spectrum β-lactamases production by uropathogenic Escherichia coli from tertiary care hospital of rural settings

“…10 Clinicians often face problems in choosing appropriate antibiotic therapy for treating UTIs caused by multi-drug-resistant (MDR) bacteria. 11 ESBLs are plasmid mediated β-lactamases that confer resistance to broad spectrum β-lactum antibiotics including third and fourth generation cephalosporins, azetronam, and extended spectrum penicillin. These plasmids often encode mutations which confer resistance to other broad-spectrum agents including aminoglycosides, co-trimoxazole and fluoroquinolones, resulting in organism resistant to most broad spectrum antibiotics.…”

Fosphomycin: Current Scenario and Susceptibility Pattern in Urinary Isolates of a Teaching Hospital

“…[13] The sensitivity to fosfomycin in E coli isolates was less when compared to other study 85% in OPD isolates and 79% in IPD isolates. [14,15] As CLSI does not mention the zone size for Klebsiella sp and Pseudomonas sp, values were interpreted with respect to CLSI interpretative criteria for E. coli. The sensitivity of E coli and Klebsiella sp was more when compared to study done by Zafar et al [13] Same study reports sensitivity of Psudomonas sp to 100% whereas in this study the sensitivity is 41-50%.…”

Antibiotics And Bacteria: Mechanisms Of Action And Resistance Strategies

“…Kolejną klasą substancji przeciwbakteryjnych wywo łujących zaburzenia syntezy ściany komórkowej bakterii są pochodne kwasu fosfonowego, do których należy fosfomycyna [6,34]. Antybiotyk ten łączy się nieodwracalnie z cysteiną, w miejscu aktywnym transferazy (MurA, UDP-N-acetyloglukozoamino-eno lo pirogronotransferazy) katalizującej przyłączanie fosfo enolopirogronianu (PEP) do N-acetyloglukozamino-urydynodifosforanu (UDP-GlcNAc).…”