Fosfomycin, interesting alternative drug for treatment of urinary tract infections created by multiple drug resistant and extended spectrum β-lactamase producing strains.
OBJECTIVE
The emergence and spread of multidrug resistant (MDR) and extended spectrum β-lactamase (ESBL) producing strains reduces the number of effective drugs that can be used for treatment. The aim of this study was to evaluate the susceptibility profile of Enterobacteriaceae isolated from UTIs, specifically MDR and ESBL producing strains, to fosfomycin and other antibiotics.


METHODS
The study was performed during a 6 month period (February 2014 to August 2015). A total of 219 non-duplicate urinary isolates of Enterobacteriaceae were collected. Identification and susceptibility testing was done according to standard microbiological procedures and the Kirby-Bauer test, respectively. Based on the results obtained from susceptibility testing, MDR bacteria were recovered and identification of ESBL production was done according to CLSI recommendation.


RESULTS
Isolates of E. coli and Klebsiella spp. were responsible for 80.8% and 12.8% of patients with UTIs respectively. The rates of resistance to ampicillin, cefazolin, nalidixic acid, trimethoprim-sulfamethoxazole were 86.3%, 79.4%, 68.5% and 63.9% respectively. In contrast, high sensitivity rates were detected to fosfomycin, amikacin and amoxicillin-clavulanic acid with 97.3%, 91.8% and 80.8%, respectively. Of all isolates, 167 (76.3%) were detected as MDR and 75 (34.2%) as ESBL producing strains.


CONCLUSIONS
The rate of antibiotic resistance among uropathogens Enterobacteriaceae is remarkably high. The most effective antibiotic was fosfomycin. Moreover, susceptibility to fosfomycin is over 90% for MDR and ESBL producer isolates. Therefore, fosfomycin can be a good option for treating UTIs.
Tropical and Infectious Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Fatemeh
F
Yeganeh-Sefidan
Tropical and Infectious Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Reza
R
Ghotaslou
Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Mohammad Taghi
MT
Akhi
Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Mohammad Reza
MR
Sadeghi
Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Yalda
Y
Mohammadzadeh-Asl
Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Hussein
H
Bannazadeh Baghi
ESBL; Enterobacteriaceae; Fosfomycin; MDR; UTIs