Activity of fosfomycin and comparison of several susceptibility testing methods against contemporary urine isolates.
Fosfomycin is recommended as first-line treatment for acute uncomplicated cystitis in women. It has demonstrated in vitro activity against a variety of pathogens; however, a paucity of data are available from the USA. We determined the susceptibility of a collection of urine isolates to fosfomycin and compared multiple methods of susceptibility testing. Consecutive non-duplicate Enterobacteriaceae, enterococci and Pseudomonas aeruginosa isolates were collected from the clinical microbiology laboratory between August 2013 and January 2014. Isolates represented hospitalised or emergency department patients with monomicrobial bacteriuria. Fosfomycin MICs were determined in duplicate, on separate days, by Etest and disk diffusion and results were compared with agar dilution. Nitrofurantoin and ciprofloxacin were used as comparators. MIC results were categorised using Clinical and Laboratory Standards Institute interpretive criteria for Escherichia coli and Enterococcus faecalis. Correlation between the three testing methods was evaluated. Overall susceptibility to fosfomycin was 94.4%, 93.5% and 87.9% by agar dilution, disk diffusion and Etest, respectively. Five fosfomycin-resistant isolates were identified, including two Morganella morganii, one P. aeruginosa, one Proteus mirabilis and one Enterobacter aerogenes. Across all organisms, rates of essential agreement, categorical agreement, minor errors, major errors and very major errors for Etest/disk diffusion compared with agar dilution were 77.3%/NA, 89.5/93.8%, 7.1/5.0%, 3.6/1.3% and 0/0%, respectively. Fosfomycin displayed fairly consistent activity against a majority of isolates collected when using the susceptibility breakpoint of 64 μg/mL. MICs for E. coli were particularly low (≤2 μg/mL). These data lend support to current guidelines that recommend fosfomycin as empirical first-line therapy for uncomplicated UTI.
Northeastern University, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA. Electronic address: e.hirsch@neu.edu.
Elizabeth B
EB
Hirsch
Northeastern University, Boston, MA, USA.
Brian R
BR
Raux
Northeastern University, Boston, MA, USA.
Paola C
PC
Zucchi
Northeastern University, Boston, MA, USA.
Yisu
Y
Kim
Beth Israel Deaconess Medical Center, Boston, MA, USA.
Christopher
C
McCoy
Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
James E
JE
Kirby
Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Sharon B
SB
Wright
Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
George M
GM
Eliopoulos
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001437:Bacteriuria / Q000188:drug therapy* / Q000382:microbiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D003556:Cystitis / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use*; D006801:Humans; D008826:Microbial Sensitivity Tests; D009582:Nitrofurantoin / Q000627:therapeutic use; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D001743:Urinary Bladder / Q000382:microbiology
D000900:Anti-Bacterial Agents; D005578:Fosfomycin; D002939:Ciprofloxacin; D009582:Nitrofurantoin
Carbapenem-resistant Enterobacteriaceae; Multidrug-resistant; UTI; Uropathogens