Fosfomycin, interesting alternative drug for treatment of urinary tract infections created by multiple drug resistant and extended spectrum β-lactamase producing strains
-
Fatemeh Yeganeh-Sefidan
,
Reza Ghotaslou
,
Mohammad Taghi Akhi
,
Mohammad Reza Sadeghi
,
Yalda Mohammadzadeh-Asl
,
Hossein Bannazadeh Baghi
Abstract
Background and Objectives: 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.
Materials and 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.
Conclusion: The rate of antibiotic resistance among uropathogens Enterobacteriaceae is remarkably high. The most effec- tive 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.
Maraki S, Samonis G, Rafailidis PI, Vouloumanou EK, Mavromanolakis E, Falagas ME. Susceptibility of uri- nary tract bacteria to fosfomycin. Antimicrob Agents Chemother 2009;53:4508-4510.
Sultan A, Rizvi M, Khan F, Sami H, Shukla I, Khan HM. Increasing antimicrobial resistance among uropathogens: Is fosfomycin the answer? Urol Ann 2015;7:26-30.
Nilsson AI, Berg OG, Aspevall O, Kahlmeter G, An- dersson DI. Biological costs and mechanisms of fos- fomycin resistance in Escherichia coli. Antimicrob Agents Chemother 2003;47:2850-2858.
Oteo J, Orden B, Bautista V, Cuevas O, Arroyo M, Martínez-Ruiz R, et al. CTX-M-15-producing urinary Escherichia coli O25b-ST131-phylogroup B2 has ac- quired resistance to fosfomycin. J Antimicrob Chemo- ther 2009;64:712-717.
Püllukcü H, Aydemir S, Işikgöz Taşbakan M, ÇiLLi F, Tünger A, Ulusoy S. Susceptibility of extended-spec- trum beta-lactamase-producing Escherichia coli urine isolates to fosfomycin, ciprofloxacin, amikacin and trimethoprim-sulfamethoxazole. Turk J Med Sci 2008;38:175-180.
Demir T, Buyukguclu T. Evaluation of the in vitro ac- tivity of fosfomycin tromethamine against Gram-neg- ative bacterial strains recovered from community- and hospital-acquired urinary tract infections in Turkey. Int J Infect Dis 2013;17:e966-970.
Neuner EA, Sekeres J, Hall GS, van Duin D. Experience with fosfomycin for treatment of urinary tract infec- tions due to multidrug-resistant organisms. Antimicrob Agents Chemother 2012;56:5744-5748.
Lee SY, Park YJ, Yu JK, Jung S, Kim Y, Jeong SH, et al. Prevalence of acquired fosfomycin resistance among extended-spectrum β-lactamase-producing Escherich- ia coli and Klebsiella pneumoniae clinical isolates in Korea and IS26-composite transposon surrounding fosA3. J Antimicrob Chemother 2012;67:2843-2847.
. Ko KS, Suh JY, Peck KR, Lee MY, Oh WS, Kwon KT,et al. In vitro activity of fosfomycin against ciproflox-acin-resistant or extended-spectrum β-lactamase–pro- ducing Escherichia coli isolated from urine and blood. Diagn Microbiol Infect Dis 2007; 58: 111-115.
Karageorgopoulos DE, Wang R, Yu XH, Falagas ME. Fosfomycin: evaluation of the published evi- dence on the emergence of antimicrobial resistance in Gram-negative pathogens. J Antimicrob Chemother 2012;67:255-268.
Michalopoulos AS, Livaditis IG, Gougoutas V. The re- vival of fosfomycin. Int J Infect Dis 2011;15: 732-739.
Lu CL, Liu CY, Huang YT, Liao CH, Teng LJ, Turnidge JD, et al. Antimicrobial susceptibilities of commonly encountered bacterial isolates to fosfomycin deter- mined by agar dilution and disk diffusion methods. An- timicrob Agents Chemother 2011;55: 4295-4301.
Qureshi M, Asif N, Baig S. Evaluation of extended spectrum β-lactamase mediated resistance in Esche- richia coli and Klebsiella in urinary tract infection at a tertiary care hospital. Biomedica 2013;29:78.
Khoshbakht R, SalimiA, Shirzad Aski H, Keshavarzi H. Antibiotic susceptibility of bacterial strains isolated from urinary tract infections in Karaj, Iran. J Microbiol 2012;6:86-90.
Amin M, Manijeh M, Pourdangchi Z. Study of bacteria isolated from urinary tract infections and determina- tion of their susceptibility to antibiotics. Jundishapur J Microbiol 2009;3:118-123.
Khan IU, Mirza IA, Ikram A, Ali S, Hussain A, Gha- foor T. In vitroactivity of fosfomycin tromethamine against extended spectrumbeta-lactamase producing urinary tract bacteria. J Coll Physicians Surg Pak 2014;24:914-917.
Farajnia S, Alikhani MY, Ghotaslou R, Naghili B, Na- khlband A. Causative agents and antimicrobial suscep- tibilities of urinary tract infections in the northwest of Iran. Int J Infect Dis 2009;13:140-144.
Ullah F, Malik S, Ahmed J. Antibiotic susceptibility pattern and ESBL prevalence in nosocomial Esche- richia coli from urinary tract infections in Pakistan. Adric J Biotechnol 2009;8:3921-3926.
Qiao LD, Chen S, Yang Y, Zhang K, Zheng B, Guo HF,et al. Characteristics of urinary tract infection patho- gens and their in vitro susceptibility to antimicrobial agents in China: data from a multicenter study. BMJ Open 2013;3:e004152.
Demir T, Buyukguclu T. Evaluation of the in vitro ac- tivity of fosfomycin tromethamine against Gram-neg- ative bacterial strains recovered from community- and hospital-acquired urinary tract infections in Turkey. Int J Infect Dis 2013;17:e966-70.
Arslan H, Azap OK, Ergönül O, Timurkaynak F. Risk factors for ciprofloxacin resistance among Escherichia coli strains isolated from community-acquired urinary tract infections in Turkey. J Antimicrob Chemother 2005;56: 914-918.
Moniri R, Khorshidi A, Akbari H. Emergence of multi- drug resistant strains of Escherichia coli isolated from urinary tract infections. Iran J Public Health 2003;32:42-46.
Garau M, Latorre A, Alonso-Sanz M. Fosfomycin: an underrated antibiotic for urinary tract infections due to Escherichia coli. Enferm Infecc Microbiol Clin 2001;19: 462-466.
Dromigny JA, Ndoye B, Macondo EA, Nabeth P, Siby T, Perrier-Gros-Claude JD. Increasing prevalence of antimicrobial resistance among Enterobacteriaceae uropathogens in Dakar, Senegal: a multicenter study. Diagn Microbiol Infect Dis 2003;47: 595-600.
Falagas ME, Kastoris AC, Kapaskelis AM, Karageor- gopoulos DE. Fosfomycin for the treatment of multi- drug-resistant, including extended-spectrum β-lac- tamase producing, Enterobacteriaceae infections: a systematic review. Lancet Infect Dis 2010;10: 43-50.
Hoşbul T, Ozyurt M, Baylan O, Bektöre B, Ardiç N, Ceylan S, et al. In vitro activity of fosfomycin trometamol in the treatment of Escherichia coli related uncomplicated urinary tract infections. Mikrobiyol Bul 2009;43: 645-649.
Mansouri S, Abbasi S. Prevalence of multiple drug re- sistant clinical isolates of extended-spectrum beta-lact- amase producing Enterobacteriaceae in Southeast Iran. Iran J Public Health 2015;35:101-108.
| Files | ||
| Issue | Vol 8 No 2 (2016) | |
| Section | Articles | |
| Keywords | ||
| Enterobacteriacae ESBL Fosfomycin MDR UTIs | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
