Urogenit Tract Infect.  2017 Aug;12(2):77-81. 10.14777/uti.2017.12.2.77.

The Antibiotic Susceptibility of Escherichia coli from Community-Acquired Uncomplicated Urinary Tract Infection: A Focused on Fosfomycin

• Choe HS
• Lee SJ
• Chang IH
• Kim TH
• Chung H
• Chung JM
• Lee SD
• Jung JH
• Kim KH
• Min SK
• Na YG
• Yoon H
• Yu HS
• Lee MK
• Lee SJ

• KMID: 2389573
• DOI: http://doi.org/10.14777/uti.2017.12.2.77

Abstract

PURPOSE
To assess the antibiotic susceptibility of Escherichia coli from community-acquired uncomplicated urinary tract infection (UTI).
MATERIALS AND METHODS
Between August and December of 2015, confirmed cases of E. coli as a pathogen of community-acquired uncomplicated UTI were collected and assessed for antibiotic susceptibility in 10 designated hospitals. Additional fosfomycin susceptibility test was performed by a central laboratory using the disk diffusion method.
RESULTS
A total of 347 E. coli isolates were collected from urine samples of community-acquired uncomplicated UTIs patients. The susceptibility rates of antibiotics were as follows: amikacin 100.0% (347), imipenem 100.0% (347), ciprofloxacin 57.1% (198), cefotaxime 74.9% (260), ampicillin 30.0% (104), trimethoprim/sulfamethoxazole 66.9% (232), and fosfomycin 98.0% (340). All fosfomycin-resistant E. coli isolates were extended-spectrum β-lactamase (ESBL)-producing. In 85 cases of ESBL-producing E. coli, the fosfomycin susceptibility rate was 91.8% (78/85).
CONCLUSIONS
Fosfomycin may be a useful option for the treatment of community-acquired uncomplicated UTIs. Further studies evaluating the role of fosfomycin in the treatment of UTIs and its clinical efficacy are necessary.

Keyword

Drug resistance; Fosfomycin; Urinary tract infections

MeSH Terms

Amikacin
Ampicillin
Anti-Bacterial Agents
Cefotaxime
Ciprofloxacin
Diffusion
Drug Resistance
Escherichia coli*
Escherichia*
Fosfomycin*
Humans
Imipenem
Methods
Treatment Outcome
Urinary Tract Infections*
Urinary Tract*
Amikacin
Ampicillin
Anti-Bacterial Agents
Cefotaxime
Ciprofloxacin
Fosfomycin
Imipenem

Reference

1. Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012; 366:1028–1037.

2. Jorgensen JH, Ferraro MJ. Antimicrobial susceptibility testing: a review of general principles and contemporary practices. Clin Infect Dis. 2009; 49:1749–1755.

3. Kim HY, Lee SJ, Lee DS, Yoo JM, Choe HS. Microbiological characteristics of unresolved acute uncomplicated cystitis. Microb Drug Resist. 2016; 22:387–391.

4. Miller LG, Tang AW. Treatment of uncomplicated urinary tract infections in an era of increasing antimicrobial resistance. Mayo Clin Proc. 2004; 79:1048–1053. quiz 1053-4.

5. Dhariwal AK, Tullu MS. Colistin: re-emergence of the ‘forgotten’ antimicrobial agent. J Postgrad Med. 2013; 59:208–215.

6. Popovic M, Steinort D, Pillai S, Joukhadar C. Fosfomycin: an old, new friend? Eur J Clin Microbiol Infect Dis. 2010; 29:127–142.

7. Saiprasad PV, Krishnaprasad K. Exploring the hidden potential of fosfomycin for the fight against severe Gram-negative infections. Indian J Med Microbiol. 2016; 34:416–420.

8. Raz R. Fosfomycin: an old--new antibiotic. Clin Microbiol Infect. 2012; 18:4–7.

9. Thaden JT, Pogue JM, Kaye KS. Role of newer and re-emerging older agents in the treatment of infections caused by carbapenem-resistant Enterobacteriaceae. Virulence. 2017; 8:403–416.

10. Naber KG, Thyroff-Friesinger U. Fosfomycin trometamol versus ofloxacin/co-trimoxazole as single dose therapy of acute uncomplicated urinary tract infection in females: a multicentre study. Infection. 1990; 18:Suppl 2. S70–S76.

11. Karageorgopoulos DE, Wang R, Yu XH, Falagas ME. Fosfomycin: evaluation of the published evidence on the emergence of antimicrobial resistance in Gram-negative pathogens. J Antimicrob Chemother. 2012; 67:255–268.

12. Oteo J, Orden B, Bautista V, Cuevas O, Arroyo M, Martinez-Ruiz R, et al. CTX-M-15-producing urinary Escherichia coli O25b-ST131-phylogroup B2 has acquired resistance to fosfomycin. J Antimicrob Chemother. 2009; 64:712–717.

13. Lorente Garin JA, Placer Santos J, Salvado Costa M, Segura Alvarez C, Gelabert-Mas A. Antibiotic resistance transformation in community-acquired urinary infections. Rev Clin Esp. 2005; 205:259–264.

14. Schito GC. Why fosfomycin trometamol as first line therapy for uncomplicated UTI? Int J Antimicrob Agents. 2003; 22:Suppl 2. 79–83.

15. Honderlick P, Cahen P, Gravisse J, Vignon D. Uncomplicated urinary tract infections, what about fosfomycin and nitrofurantoin in 2006? Pathol Biol (Paris). 2006; 54:462–466.

16. Hara T, Araake M, Watabe H. Antibacterial activities of fosfomycin against several fresh clinical isolates--comparison of the test methods for antibacterial activity. Jpn J Antibiot. 2002; 55:844–854.

17. Seo MR, Kim SJ, Kim Y, Kim J, Choi TY, Kang JO, et al. Susceptibility of Escherichia coli from community-acquired urinary tract infection to fosfomycin, nitrofurantoin, and temocillin in Korea. J Korean Med Sci. 2014; 29:1178–1181.

18. Cho YH, Jung SI, Chung HS, Yu HS, Hwang EC, Kim SO, et al. Antimicrobial susceptibilities of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in health care-associated urinary tract infection: focus on susceptibility to fosfomycin. Int Urol Nephrol. 2015; 47:1059–1066.

19. Lee SY, Park YJ, Yu JK, Jung S, Kim Y, Jeong SH, et al. Prevalence of acquired fosfomycin resistance among extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae clinical isolates in Korea and IS26-composite transposon surrounding fosA3. J Antimicrob Chemother. 2012; 67:2843–2847.