title: Antimicrobial susceptibility of vancomycin-resistant Enterococcus faecium: potential utility of fosfomycin.
abstract: The increasing prevalence of vancomycin-resistant enterococcal (VRE) infections has necessitated a search for drugs that are effective in treating these infections, and a need to determine whether currently available antimicrobials are effective. 75 consecutive clinical isolates of vancomycin-resistant Enterococcus faecium (VRE faecium) (40 blood and 35 urine isolates) isolated over 1 y at the Cleveland Clinic Foundation were tested for susceptibility to linezolid, quinupristin-dalfopristin, fosfomycin and nitrofurantoin using the Etest. The minimum inhibitory concentrations were read independently by 3 observers and compared, and a final reading was obtained by predetermined criteria. The proportion of isolates susceptible to linezolid, quinupristin-dalfopristin, fosfomycin and nitrofurantoin was 100%, 98.7%, 98.7% and 78.7%, respectively. No single isolate was resistant to more than 1 of the 4 drugs tested. Etest presented significant unexpected difficulties in testing for VRE faecium susceptibility to nitrofurantoin. Fosfomycin may be a useful alternative to linezolid and quinupristin-dalfopristin in the treatment of VRE infections in certain clinical situations, e.g. uncomplicated urinary tract infections. In addition, the use of fosfomycin could limit the use of newer agents, thus reducing the chance of development of further resistance in the enterococci.
authors.affiliation: Department of Infectious Diseases, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Nabin K
authors.initials: NK
authors.lastname: Shrestha
authors.forename: Jimmy D
authors.initials: JD
authors.lastname: Chua
authors.forename: Marion J
authors.initials: MJ
authors.lastname: Tuohy
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Wilson
authors.forename: Gary W
authors.initials: GW
authors.lastname: Procop
authors.forename: David L
authors.initials: DL
authors.lastname: Longworth
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Isada
authors.forename: Gerri S
authors.initials: GS
authors.lastname: Hall
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001769:Blood / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D016984:Enterococcus faecium / Q000187:drug effects* / Q000302:isolation & purification*; D005260:Female; D005578:Fosfomycin / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D012680:Sensitivity and Specificity; D014556:Urine / Q000382:microbiology; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents; D005578:Fosfomycin