title: In vitro activity of fosfomycin trometamol and other oral antibiotics against multidrug-resistant uropathogens.
abstract: Clinical midstream and urinary catheter isolates (n = 106) of extended-spectrum β-lactamase (ESBL)-positive Escherichia coli, Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae, Proteus mirabilis and meticillin-resistant Staphylococcus saprophyticus were tested against fosfomycin using the agar dilution method, the broth microdilution method and the gradient test described by the Clinical and Laboratory Standards Institute. Nitrofurantoin, co-trimoxazole, amoxicillin/clavulanic acid, cefuroxime, levofloxacin and ciprofloxacin were tested using the gradient test alone. Breakpoints from the European Committee on Antimicrobial Susceptibility Testing 2015 guidelines were used. Fosfomycin inhibited all of the ESBL-positive E. coli, P. mirabilis and meticillin-resistant S. saprophyticus strains isolated from urine, as well as 82% of KPC-producing K. pneumoniae isolates. Substantial agreement for fosfomycin activity was found for the three test methods, particularly for Enterobacteriaceae. This study confirmed that fosfomycin has good in vitro activity against more common multidrug-resistant uropathogens. Fosfomycin could be a reliable empirical therapeutic option for uncomplicated urinary tract infections caused by these organisms, and a valid option for sparing parenteral antibiotics, such as carbapenems.
authors.affiliation: Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy. Electronic address: mezzate@unict.it.
authors.forename: Maria Lina
authors.initials: ML
authors.lastname: Mezzatesta
authors.affiliation: Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: La Rosa
authors.affiliation: Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Maugeri
authors.affiliation: Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Zingali
authors.affiliation: Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Caio
authors.affiliation: Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Novelli
authors.affiliation: Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Stefani
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001424:Bacterial Infections / Q000382:microbiology*; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D005578:Fosfomycin / Q000494:pharmacology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D057790:Staphylococcus saprophyticus / Q000187:drug effects* / Q000302:isolation & purification; D014552:Urinary Tract Infections / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D005578:Fosfomycin
keywords: ESBL; Fosfomycin trometamol; Urinary tract infections; Uropathogens