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Background: Bacterial resistance among uropathogens is on the rise and has led to a decreased effectiveness of oral therapies. Fosfomycin tromethamine (fosfomycin) is indicated for uncomplicated urinary tract infections (UTIs) and displays in vitro activity against multidrug-resistant (MDR) isolates; however, clinical data assessing fosfomycin for the treatment of complicated or MDR UTIs are limited. Methods: We conducted a retrospective evaluation of patients who received ≥1 dose of fosfomycin between January 2009 and September 2015 for treatment of a UTI. Patients were included if they had a positive urine culture and documented signs/symptoms of a UTI. Results: Fifty-seven patients were included; 44 (77.2%) had complicated UTIs, 36 (63.2%) had MDR UTIs, and a total of 23 (40.4%) patients had a UTI that was both complicated and MDR. The majority of patients were female (66.7%) and elderly (median age, 79 years). Overall, the most common pathogens isolated were Escherichia coli (n = 28), Enterococcus spp. (n = 22), and Pseudomonas aeruginosa (n = 8). Twenty-eight patients (49.1%) were clinically evaluable; the preponderance achieved clinical success (96.4%). Fifteen out of 20 (75%) patients with repeat urine cultures had a microbiological cure. Conclusions: This retrospective study adds to the limited literature exploring alternative therapies for complicated and MDR UTIs with results providing additional evidence that fosfomycin may be an effective oral option.

cIncreasing resistance among Gram-negative uropathogens limits treatment options, and susceptibility data for multidrug-resistant isolates are limited. We assessed the activity of five oral agents against 91 multidrug-resistant Gram-negative urine isolates that were collected from emergency department/hospitalized patients. Fosfomycin and nitrofurantoin were most active (>75% susceptibility). Susceptibilities to sulfamethoxazole-trimethoprim, ciprofloxacin, and ampicillin were <40%; empirical use of these agents likely provides inadequate coverage in areas with a high prevalence of multidrug-resistant uropathogens. Multidrug resistance among Gram-negative bacilli that cause uncomplicated urinary tract infections (UTIs), such as Pseudomonas aeruginosa and Klebsiella pneumoniae, is increasing (1, 2). Such resistance significantly limits patient treatment options (3-6). There is a paucity of published data on current in vitro susceptibility profiles for multidrug-resistant (MDR) urine isolates (7,8). As UTIs are commonly treated in the outpatient setting with oral agents, knowledge of susceptibility patterns in MDR urinary pathogens is critical to guide empirical treatment (9). We therefore assessed the in vitro activity of five oral agents-fosfomycin, nitrofurantoin, sulfamethoxazole-trimethoprim, ciprofloxacin, and ampicillin-against 91 MDR Gram-negative urine isolates.(This research was presented in part at the 25th European Congress of Clinical Microbiology and Infectious Diseases, Copenhagen, Denmark, 25 to 28 April 2015.) Consecutive, nonduplicate monomicrobial urine cultures of Enterobacteriaceae and Pseudomonas aeruginosa from hospitalized or emergency department (ED) patients were collected between August 2013 and January 2014 from the Beth Israel Deaconess Medical Center (BIDMC) clinical microbiology laboratory as previously described (10). All isolates were collected from unique patients, and those from non-ED outpatient locations were excluded. Only MDR isolates, defined as nonsusceptible to Ն1 agent in at least 3 antibiotic classes, were assessed during the study period (11). BIDMC is a 649-bed level 1 trauma center and teaching hospital affiliated with Harvard Medical School. The study was approved by the Institutional Review Boards at BIDMC and Northeastern University.For further characterization of isolates meeting study criteria, those nonsusceptible to carbapenems and third/fourth-generation cephalosporins were screened for extended-spectrum ␤-lactamase (ESBL) production using double-disk testing with cefotaxime (30 g) and ceftazidime (30 g) alone and in combination with clavulanate (10 g) as recommended by the Clinical and Laboratory Standards Institute (CLSI) (12). Isolates that were nonsusceptible to carbapenems were screened for the presence of bla KPC and bla NDM by PCR and gene sequencing (13,14).Antibiotic susceptibility was determined by several methods. Fosfomycin and nitrofurantoin MICs were determined in duplicate on separate days by agar dilution as previously described (10). Ciprofl...

A multicenter case series of 21 patients were treated with imipenem-cilastatin-relebactam. There were mixed infection sources, with pulmonary infections (11/21,52%) composing the majority. The primary pathogen was Pseudomonas aeruginosa (16/21, 76%), and 15/16 (94%) isolates were multidrug-resistant. Thirty-day survival occurred in 14/21 (67%) patients. Two patients experienced adverse effects.

BackgroundThe use of tablet computers and other touch screen technology within the healthcare system has rapidly expanded. It has been reported that these devices can harbor pathogens in hospitals; however, much less is known about what pathogens they can harbor when used outside the hospital environment compared to hospital practice.MethodsThirty iPads belonging to faculty with a variety of practice settings were sampled to determine the presence and quantity of clinically-relevant organisms. Flocked nylon swabs and neutralizer solution were used to sample the surface of each iPad. Samples were then plated on a variety of selective agars for presence and quantity of selected pathogens. In addition, faculty members were surveyed to classify the physical location of their practice settings and usage patterns. Continuous variables were compared via an unpaired Student's t test with two-tailed distribution; categorical variables were compared with the Fisher's exact test.ResultsOf the iPads sampled, 16 belonged to faculty practicing within a hospital and 14 belonged to a faculty member practicing outside a hospital. More faculty within the hospital group used their iPads at their practice sites (78.6% vs. 31.3%; p = 0.014) and within patient care areas (71.4% vs. 18.8%; p = 0.009) than the non-hospital group. There were no differences in the presence, absence, or quantity of, any of the pathogens selectively isolated between groups. Problematic nosocomial pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and P. aeruginosa were isolated from both hospital and non-hospital faculty iPads.ConclusionsGram positive and Gram negative organisms were recovered from the surfaces of iPads regardless of practice setting; these included problematic multidrug-resistant pathogens like MRSA, VRE, and Pseudomonas aeruginosa. Healthcare personnel in all settings should be aware of the potential for tablet computers to serve as a nidus for microorganism transmission.