Fosfomycin Trometamol in the Management of Urinary Tract Infection: A Focus on Antimicrobial Susceptibility and Resistance
Abstract
Urinary tract infections (UTIs) are common bacterial infections in women and vulnerable populations, with increasing incidence and prevalence worldwide. Although originally classified as uncomplicated or complicated, UTIs are now classified as localized (ie, cystitis) or systemic based on clinical signs and symptoms. Oral fosfomycin trometamol, a first-line antibiotic for localized UTIs, is active against several Gram-negative and Gram-positive bacteria, including extended-spectrum β-lactamase (ESBL)-producing Enterobacterales; however, susceptibility testing and clinical breakpoints are recommended only for Escherichia coli. Susceptibility testing is also complicated by breakpoint differences of ≤64 mg/L (CLSI) versus E. coli isolates, including ESBL-producing isolates, are highly susceptible to fosfomycin, supporting its use in treating localized UTIs. For UTIs caused by E. coli, an overall 96% susceptibility rate was identified across 13 countries, with no significant differences across high-income and lower-middle-income countries (mean fosfomycin susceptibility [min. max.] 96% [95%, 97%] vs 96.75% [85%, 100%], respectively; p=0.432). Similarly, in a European-wide cross-sectional epidemiological study of E. coli urinary isolates, >95% fosfomycin susceptibility was observed in Belgium, Spain, the United Kingdom, and Russia, versus 91.7% in Italy. Fosfomycin also appears to be an appropriate treatment option for localized UTIs in developing countries, with susceptibility…
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