Determination of Susceptibility to Fosfomycin and Tigecycline of Enterobacteriaceae, Particularly Escherichia coli Isolates, Producing Extended‐Spectrum β‐Lactamases from Multiple Regional Canadian Hospitals

Beuk, Carlee; Hill, C D; Whitehead, Sue; Blondel-Hill, Edith; Wagner, Ken; Cheeptham, Naowarat

doi:10.1155/2013/645018

Cited by 8 publications

(6 citation statements)

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“…20 Two recently published Canadian studies reported fosfomycin susceptibilities ranging from 94.9% to 100% for ESBL-and AmpC ß-lactamase-producing E. coli. 21,22 In the current study, the susceptibility rate of 96% falls within this previously reported range. In studies from other countries, [23][24][25] susceptibility rates for Klebsiella spp.…”

Section: Discussionsupporting

confidence: 90%

Fosfomycin Susceptibility in Multidrug- Resistant Enterobacteriaceae Species and Vancomycin-Resistant Enterococci Urinary Isolates

Nadeau

2017

CJHP

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ABSTRACTBackground: Broad-spectrum antibiotics are often used to treat urinary tract infections (UTIs) due to drug-resistant species of Enterobacteriaceae and Enterococcus (e.g., organisms producing extended-spectrum ß-lactamase [ESBL] or AmpC ß-lactamase, as well as vancomycin-resistant enterococci [VRE]). However, this type of therapy can promote selection of resistant organisms and may necessitate venous access. Fosfomycin is an orally administered, single-dose antibiotic for the treatment of uncomplicated UTI. Little is known about its microbiologic activity against urinary isolates, including in southwestern Ontario, since fosfomycin susceptibility testing is not routinely performed.Objective: To explore a cost-effective alternative for the treatment of lower UTIs caused by multidrug-resistant Enterobacteriaceae and VRE organisms resistant to usual first-line therapies by determining fosfomycin susceptibility rates.Methods: Urinary isolates were collected prospectively from November 2015 to April 2016 at 3 hospitals in southwestern Ontario. Susceptibility testing was completed according to guidelines of the Clinical and Laboratory Standards Institute, with interpretation by zone of inhibition (as diameter in millimetres). Patients 18 years of age or older with isolation of multidrug-resistant Enterobacteriaceae or VRE were eligible for inclusion. Urinary isolates from these patients were subjected to susceptibility testing. The primary outcome was the rate of fosfomycin susceptibility of these isolates.Results: A total of 137 urinary isolates were tested: 106 positive for ESBL or AmpC ß-lactamase producing Enterobacteriaceae (95 Escherichia coli, 11 Klebsiella spp.) and 31 positive for vancomycin-resistant Enterococcus faecium. Susceptibility rates for ESBL- and AmpC ß-lactamase producing E. coli were 100% for ertapenem, 96% for fosfomycin, 83% for nitro - furantoin, 72% for gentamicin, 56% for trimethoprim-sulfamethoxazole, and 14% for ciprofloxacin. Susceptibility rates of vancomycin-resistant E. faecium urinary isolates were 100% for linezolid, 81% for fosfomycin, 68% for tetracycline, 6% for ampicillin, 3% for penicillin, and 0% for both nitrofurantoin and ciprofloxacin.Conclusion: Given susceptibility rates at the study institutions, fosfomycin was deemed the most reliable oral option for the treatment of lower UTI in patients with suspected or documented multidrug-resistant uropathogens.RÉSUMÉContexte : Les antibiotiques à large spectre sont souvent employés pour traiter les infections urinaires causées par des espèces d’entérobactériacées et d’Enterococcus résistantes aux médicaments (par exemple, des organismes qui produisent des ß-lactamases à spectre étendu [BLSE] ou des ß-lactamases AmpC de même que des entérocoques résistants à la vancomycine [ERV]). Or, ce type de traitement peut favoriser la sélection d’organismes résistants et peut nécessiter un accès veineux. La fosfomycine est un antibiotique oral à dose unique servant au traitement d’infections urinaires non compliquées. On connaît peu de choses sur son activité microbiologique contre les isolats urinaires, en l’occurrence dans le sudouest de l’Ontario, car on ne teste pas systématiquement la fosfomycine dans les antibiogrammes.Objectif : Chercher une solution ayant un bon rapport coût-efficacité pour le traitement des infections urinaires basses causées par des espèces d’entérobactériacées multirésistantes aux antibiotiques et des ERV qui ne répondent pas aux traitements de première intention normalement utilisés en déterminant les degrés de sensibilité à l’égard de la fosfomycine.Méthodes : Des isolats urinaires ont été recueillis de façon prospective entre novembre 2015 et avril 2016 dans trois hôpitaux du sud-ouest de l’Ontario. Des antibiogrammes ont été réalisés selon les lignes directrices du Clinical and Laboratory Standards Institute, et l’interprétation était fondée sur la zone d’inhibition (soit le diamètre en millimètres). Les patients de 18 ans et plus chez qui on avait isolé des entérobactériacées ou des ERV multirésistants aux antibiotiques étaient admissibles à l’étude. Les isolats urinaires provenant de ces patients étaient soumis à un antibiogramme. Le principal paramètre d’évaluation était le taux de sensibilité à la fosfomycine des isolats urinaires.Résultats : Au total, 137 isolats urinaires ont été testés; 106 étaient positifs pour des espèces d’entérobactéricées produisant des BLSE ou des ßlactamases AmpC (95 Escherichia coli, 11 espèces de Klebsiella) et 31 étaient positifs pour l’Enterococcus faecium résistant à la vancomycine. Les taux de sensibilité d’E. coli produisant des BLSE et des ß-lactamases AmpC étaient de 100 % pour l’ertapénem, 96 % pour la fosfomycine, 83 % pour la nitrofurantoïne, 72 % pour la gentamicine, 56 % pour le co-trimoxazole et 14 % pour la ciprofloxacine. Les taux de sensibilité pour les isolats urinaires d’Enterococcus faecium résistant à la vancomycine étaient de 100 % pour le linézolide, 81 % pour la fosfomycine, 68 % pour la tétracycline, 6 % pour l’ampicilline, 3 % pour la pénicilline et 0 % pour la nitrofurantoïne et la ciprofloxacine.Conclusion : En raison des taux de sensibilité obtenus aux établissements à l’étude, la fosfomycine a été jugée comme le médicament oral le plus fiable pour le traitement des infections urinaires basses chez les patients pour lesquels la présence d’uropathogènes multirésistants aux antibiotiques est soupçonnée ou connue.

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Section: Discussionsupporting

confidence: 90%

Fosfomycin Susceptibility in Multidrug- Resistant Enterobacteriaceae Species and Vancomycin-Resistant Enterococci Urinary Isolates

Nadeau

2017

CJHP

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“…Consequently, the therapeutic armamentarium becomes very limited. Tigecycline has activity against ESBL-producing bacteria, however, due to its pharmacokinetics, it is not ideal for the treatment of urinary tract infections [60]. Colistin has recently become the “last resort” antibiotic in the therapy of Gram-negative MDR infections: it has shown clinical effectiveness where other options were not available, however, this drug cases severe nephrotoxicity and neurotoxicity.…”

Section: Discussionmentioning

confidence: 99%

Resistance Trends and Epidemiology of Citrobacter-Enterobacter-Serratia in Urinary Tract Infections of Inpatients and Outpatients (RECESUTI): A 10-Year Survey

Gajdács

Urbán

2019

Medicina

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Background and objectives: Urinary tract infections (UTIs) are the third most common infections in humans, representing a significant factor of morbidity, both among outpatients and inpatients. The pathogenic role of Citrobacter, Enterobacter, and Serratia species (CES bacteria) has been described in UTIs. CES bacteria present a therapeutic challenge due to the various intrinsic and acquired resistance mechanisms they possess. Materials and Methods: The aim of this study was to assess and compare the resistance trends and epidemiology of CES pathogens in UTIs (RECESUTI) in inpatients and outpatients during a 10-year study period. To evaluate the resistance trends of isolated strains, several antibiotics were chosen as indicator drugs based on local utilization data. 578 CES isolates were obtained from inpatients and 554 from outpatients, representing 2.57 ± 0.41% of all positive urine samples for outpatients and 3.02 ± 0.40% for inpatients. E. cloacae was the most prevalent species. Results: The ratio of resistant strains to most of the indicator drugs was higher in the inpatient group and lower in the second half of the study period. ESBL-producing isolates were detected in 0–9.75% from outpatient and 0–29.09% from inpatient samples. Conclusions: Resistance developments of CES bacteria, coupled with their intrinsic non-susceptibility to several antibiotics, severely limits the number of therapeutic alternatives, especially for outpatients.

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“…In UTIs with an ESBL-producing isolate (coupled with other resistance mechanisms), carbapenems essentially remain the only safe drug choice, while other “last resort” agents (e.g., tigecycline, colistin, ceftazidime-avibactam) are rarely used, due to their price, pharmacokinetic profile or side effects. Multidrug resistance (MDR) in Gram-negative bacteria is a growing concern, and the treatment of UTIs is increasingly complex challenge for clinicians [25,41,42,43,44]. These uropathogens may be resistant to a wide range of available drugs, necessitating the use of drugs that are only available in intravenous formulations, limiting the care of these patients to inpatient setting or outpatient parenteral antimicrobial therapy (OPAT), if available [45,46].…”

Section: Introductionmentioning

confidence: 99%

Comparative Epidemiology and Resistance Trends of Common Urinary Pathogens in a Tertiary-Care Hospital: A 10-Year Surveillance Study

et al. 2019

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Background and Objective: Urinary tract infections (UTIs) are common in human medicine, affecting large patient populations worldwide. The principal cause of UTIs is uropathogenic Escherichia coli (UPEC) and Klebsiella, both in community and nosocomial settings. The assessment of local data on prevalence and resistance is essential to evaluate trends over time and to reflect on the national situation, compared to international data, using the methods of analytical epidemiology. Materials and Methods: The aim of this study was to assess resistance trends and epidemiology of UTIs caused by E. coli and Klebsiella species in inpatients and outpatients at a tertiary-care hospital in Hungary, using microbiological data. To evaluate resistance trends, several antibiotics were chosen as indicator drugs, based on local utilization data. Results: E. coli was the most prevalent isolate, representing 56.75 ± 4.86% for outpatients and 42.29 ± 2.94% for inpatients. For E. coli, the ratio of resistant strains for several antibiotics was significantly higher in the inpatient group, while in Klebsiella, similar trends were only observed for gentamicin. Extended-spectrum β-lactamase (ESBL)-producing isolates were detected in 4.33–9.15% and 23.22–34.22% from outpatient, 8.85–38.97% and 10.89–36.06% from inpatient samples for E. coli and Klebsiella, respectively. Conclusions: Resistance developments in common UTI pathogens (especially to fosfomycin, sulfamethoxazole-trimethoprim, fluoroquinolones, and 3rd generation cephalosporins), seriously curb therapeutic options, especially in outpatient settings.

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Determination of Susceptibility to Fosfomycin and Tigecycline of Enterobacteriaceae, Particularly Escherichia coli Isolates, Producing Extended‐Spectrum β‐Lactamases from Multiple Regional Canadian Hospitals

Abstract: Although resistance to these antibiotics has previously been reported, the present study confirmed that isolates of ESBL-producing E coli from the Interior Health Region of British Columbia remain highly susceptible to both tigecycline and fosfomycin.

Cited by 8 publications

References 10 publications

Fosfomycin Susceptibility in Multidrug- Resistant Enterobacteriaceae Species and Vancomycin-Resistant Enterococci Urinary Isolates

Fosfomycin Susceptibility in Multidrug- Resistant Enterobacteriaceae Species and Vancomycin-Resistant Enterococci Urinary Isolates

Resistance Trends and Epidemiology of Citrobacter-Enterobacter-Serratia in Urinary Tract Infections of Inpatients and Outpatients (RECESUTI): A 10-Year Survey

Comparative Epidemiology and Resistance Trends of Common Urinary Pathogens in a Tertiary-Care Hospital: A 10-Year Surveillance Study

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