Antimicrobial susceptibilities of clinical bacterial isolates from urinary tract infections to fosfomycin and comparator antibiotics determined by agar dilution method and automated micro broth dilution
Abstract
UNLABELLED: Uncomplicated bacteremic urinary tract infections (bUTIs) are common, often caused by Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis, with most encounters treated empirically. As rates of antimicrobial resistance increase, available antibiotic treatment options are dwindling. Novel antibiotics approved for treating bUTIs are limited, leading to a resurgence of interest in older antibiotics, including fosfomycin. Here, clinical urine samples from patients including military personnel, retirees, and their dependents diagnosed with bUTIs from a military hospital located in Bethesda, Maryland, were tested for susceptibility to fosfomycin and comparator antibiotics (levofloxacin, nitrofurantoin, and trimethoprim-sulfamethoxazole [TMS]). A total of 1,353 nonduplicate bacterial isolates were tested, including 605 non-ESBL and 285 ESBL E. coli, and 84 non-ESBL and 52 ESBL K. pneumoniae. Fosfomycin susceptibility rates were similar for non-ESBL and ESBL E. coli (95.9% vs 96.1%) and K. pneumoniae (38.1% vs 36.5%). Fosfomycin demonstrated high activity against other Enterobacterales and gram-positive organisms including Enterobacter faecalis and Staphylococcus aureus. Interestingly, most fosfomycin non-susceptible isolates were susceptible to other first-line bUTI treatment options, and most isolates that were non-susceptible to other first-line bUTI treatment option were susceptible to fosfomycin. ESBL K. pneumoniae isolates were the least susceptible…
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