Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: In vitro Susceptibility to Fosfomycin, Nitrofurantoin and Tigecycline

Abstract

Objective: To assess the susceptibility trends of community-acquired extended-spectrum β-Iactamase (ESBL)-producing urinary isolates with particular reference to fosfomycin, nitrofurantoin and tigecycline. Materials and Methods: Seven hospitals across the United Arab Emirates participated in this study from June 2008 to March 2010. The antibiotic sensitivity of ESBL-producing uropathogens to a panel of antibiotics including tigecycline, fosfomycin and nitrofurantoin was assessed. The Hyplex ESBL identification system (h-ES-ID) was used for genotypic identification. Results: Two hundred and ninety-two ESBL-producing Enterobacteriaceae isolates were identified during the study period. Of these, 182 (62%) were urinary isolates and comprised of Escherichia coli: 149 (81.9%), Klebsiella pneumoniae: 30 (16.5%) and Proteus mirabilis: 3 (1.6%). Of the 182 urinary isolates, 179 (98.3%) were from patients with community onset urinary tract infections. The h-ES-ID system identified 172 (94.5%) of the urinary isolates as CTX-M positive. All isolates were susceptible to imipenem and meropenem. Over half of the isolates showed resistance to gentamicin (98; 53.8%), trimethoprim-sulfamethoxazole (139; 76.4%) and ciprofloxacin (143; 78.6%). Sensitivity to nitrofurantoin and fosfomycin was 90 and 100%, respectively. Two CTX-M-positive K. pneumoniae isolates with tigecycline resistance (MIC >4 µg/ml) were identified. Conclusion: There is dissemination of CTX-M ESBL-producing urinary pathogens into the community. Fosfomycin and nitrofurantoin were active against ESBL-positive uropathogens, and emergence of tigecycline resistance needs close monitoring.

Detection of Antibiotic Resistance Determinants and Their Transmissibility among Clinically Isolated Carbapenem-Resistant <b><i>Escherichia coli</i></b> from South India

“…The emergence of multidrug-resistant E. coli and their rapid spread and ability to continuously evolve pose a serious threat to global health [5,23,24]. Carbapenemaseproducing Enterobacteriaceae due to the presence of NDM and OXA β-lactamases have been reported in various medical centers globally as well as in India [25][26][27][28][29].…”

Antimicrobial Effect and Transdentinal Diffusion of New Intracanal Formulations Containing Nitrofurantoin or Doxycycline

“…However, regarding the antimicrobial component of MTAD (doxycycline), some authors claim that nitrofurantoin, a synthetic nitrofuran commonly used in urinary tract infections where E. faecalis is usually involved (17,18), has demonstrated better efficacy than doxycicline against the same bacteria (18).…”

Infectious diseases in the Arabian Peninsula and Egypt

“…Nevertheless, it is apparent that ESBL‐producing pathogens are now entrenched as important agents of antimicrobial resistance in the region. The increasing occurrence of community‐acquired infections and faecal carriage in healthy individuals is of concern [79–81].…”

“…Reports from a limited number of studies indicate that isolates harbouring the bla CTX‐M genotype are increasingly being implicated in nosocomial infections, including outbreaks and community‐acquired infections [80–83]. Emerging data from across the region indicate that the proportion of ESBL‐producing isolates habouring bla CTX‐M is as high as 83–94.5% in the UAE [81,84], 77.9% in Kuwait [85], and 38.9–100% in Egypt [86–88]. In Saudi Arabia, two studies have reported bla CTX‐M detection in 34% and 71% of Enterobacteriaceae [89,90].…”