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Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, Todi SK, Mohan A, Hegde A, Jagiasi BG, Krishna B, Rodrigues C, Govil D, Pal D, Divatia JV, Sengar M, Gupta M, Desai M, Rungta N, Prayag PS, Bhattacharya PK, Samavedam S, Dixit SB, Sharma S, Bandopadhyay S, Kola VR, Deswal V, Mehta Y, Singh YP, Myatra SN. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024; 28:S104-S216. [PMID: 39234229 PMCID: PMC11369928 DOI: 10.5005/jp-journals-10071-24677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 09/06/2024] Open
Abstract
How to cite this article: Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, et al. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024;28(S2):S104-S216.
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Affiliation(s)
- Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Subhash K Todi
- Department of Critical Care, AMRI Hospital, Kolkata, West Bengal, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Ashit Hegde
- Department of Medicine & Critical Care, P D Hinduja National Hospital, Mumbai, India
| | - Bharat G Jagiasi
- Department of Critical Care, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, Maharashtra, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, India
| | - Camila Rodrigues
- Department of Microbiology, P D Hinduja National Hospital, Mumbai, India
| | - Deepak Govil
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Divya Pal
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mukesh Desai
- Department of Immunology, Pediatric Hematology and Oncology Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Narendra Rungta
- Department of Critical Care & Anaesthesiology, Rajasthan Hospital, Jaipur, India
| | - Parikshit S Prayag
- Department of Transplant Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Pradip K Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Srinivas Samavedam
- Department of Critical Care, Ramdev Rao Hospital, Hyderabad, Telangana, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Sudivya Sharma
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Susruta Bandopadhyay
- Department of Critical Care, AMRI Hospitals Salt Lake, Kolkata, West Bengal, India
| | - Venkat R Kola
- Department of Critical Care Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Vikas Deswal
- Consultant, Infectious Diseases, Medanta - The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Yogendra P Singh
- Department of Critical Care, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Anastasia A, Bonura S, Rubino R, Giammanco GM, Miccichè I, Di Pace MR, Colomba C, Cascio A. The Use of Intravenous Fosfomycin in Clinical Practice: A 5-Year Retrospective Study in a Tertiary Hospital in Italy. Antibiotics (Basel) 2023; 12:971. [PMID: 37370290 DOI: 10.3390/antibiotics12060971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Fosfomycin in intravenous (IV) formulation has re-emerged as a valuable tool in the treatment of multi-drug resistant (MDR) and extensively drug-resistant (XDR) infections because of its broad spectrum of antibacterial action and pharmacokinetic characteristics. This retrospective study aimed to evaluate how fosfomycin was used in patients admitted to the Polyclinic of Palermo between January 2017 and July 2022. Clinical indications, therapeutic associations, clinical outcomes, and any side effects were analyzed. Intravenous fosfomycin was used in 343 patients, 63% male, with a mean age of 68 years (range 15-95). Urinary tract infections (UTIs) and hospital-acquired pneumonia (HAP) were the main indications for treatment (19% and 18% of the total cases, respectively), followed by skin and soft tissue infections and sepsis. IV fosfomycin was administered in combination with other antibacterial agents, the most common of which were ceftazidime/avibactam (35%), meropenem (17%), and colistin (14%). Nineteen patients received it as monotherapy for UTIs. About 66% had resolution of the infectious process with clinical remission (cure or discharge). Electrolyte disturbances occurred in 2.6% and gastrointestinal symptoms occurred in 2.9%. The data showed that IV fosfomycin is a safe and effective therapeutic option in the treatment of infections with multidrug-resistant microorganisms.
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Affiliation(s)
- Antonio Anastasia
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, 90127 Palermo, Italy
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
| | - Silvia Bonura
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
- Antimicrobial Stewardship Team, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
| | - Raffaella Rubino
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
- Antimicrobial Stewardship Team, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
| | - Giovanni Maurizio Giammanco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, 90127 Palermo, Italy
- Antimicrobial Stewardship Team, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
- Microbiology and Virology Unit, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
| | - Irene Miccichè
- Antimicrobial Stewardship Team, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
- UOC Farmacia, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
| | - Maria Rita Di Pace
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, 90127 Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro", University of Palermo, 90127 Palermo, Italy
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
- Antimicrobial Stewardship Team, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy
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Kassabian M, Calderwood MS, Ohsfeldt R. A Cost-Effectiveness Analysis of Fosfomycin: A Single-Dose Antibiotic Therapy for Treatment of Uncomplicated Urinary Tract Infection. Health Serv Insights 2022; 15:11786329221126340. [PMID: 36245475 PMCID: PMC9554122 DOI: 10.1177/11786329221126340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022] Open
Abstract
Nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX) and fosfomycin are first-line therapeutics for uncomplicated urinary tract infections (uUTI). While fosfomycin is the most expensive, it is also attractive due to its effectiveness against most uUTI-causing bacteria, limited risk of cross-resistance with other drugs, and single-dose delivery. In light of these competing attributes, a cost-effectiveness analysis can provide useful, standardized information about tradeoffs between fosfomycin and treatment alternatives. This paper assessed cost-effectiveness via incremental cost-effectiveness ratios (ICERs) that represented a drug’s incremental cost per additional uUTI case resolved with initial course of antibiotic therapy. The study setting was New Hampshire, USA. Total cost of treatment was lowest with TMP-SMX and highest with fosfomycin. ICERs were $84.53 and $78.59 for nitrofurantoin and $2264.29 and $2260.89 for fosfomycin under a payer and societal perspective, respectively. While no standard benchmark for our measure of cost-effectiveness exists, the high national prevalence of antibiotic stewardship efforts suggests that willingness-to-pay to increase the number of people who are successfully treated with an initial course of therapy is non-zero. Ultimately, fosfomycin may currently be considered a cost-effective option for treating uUTI in the US. As a recently off-patent drug, increased competition in the generic market may improve its cost-effectiveness in the future.
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Affiliation(s)
- Morgan Kassabian
- Department of Health Policy & Management, Texas A&M School of Public Health, College Station, TX, USA,Morgan Kassabian, Department of Health Policy & Management, Texas A&M School of Public Health, TAMU 1266, College Station, TX 77843, USA.
| | | | - Robert Ohsfeldt
- Department of Health Policy & Management, Texas A&M School of Public Health, College Station, TX, USA
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Zirpe KG, Mehta Y, Pandit R, Pande R, Deshmukh AM, Patil S, Bhagat S, Barkate H. A Real-world Study on Prescription Pattern of Fosfomycin in Critical Care Patients. Indian J Crit Care Med 2021; 25:1055-1058. [PMID: 34963727 PMCID: PMC8664030 DOI: 10.5005/jp-journals-10071-23958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background This study presents a real-world scenario for prescription pattern, efficacy, and safety data on the current clinical use of intravenous fosfomycin in critically ill patients in Indian settings. Patients and methods This was a retrospective cohort study conducted for a period of 10 months among critically ill patients admitted to hospital's critical care unit. The primary objective of the study was to analyze the prescription pattern of intravenous fosfomycin, and the secondary objective was to evaluate the safety profile and patient outcomes. Results A total of 309 patients were enrolled, and they were diagnosed with bacteremia (45.3%), pneumonia (15.85%), septic shock (14.24%), and urinary tract infections (UTI) (13.91%). The average dose of fosfomycin given was 11.7 ± 4.06 gm/day. The average duration of the therapy was 4.85 ± 3.59 days with a median duration of 4 days. Fosfomycin was given at 8 hourly dosing frequency to maximum (45.6%) cases. Hypokalemia was the most observed adverse event. The overall survival was seen in 55% of patients. Conclusion Our data suggest that UTI, infection caused by Escherichia coli, and a daily dose of >12 g were associated with better clinical outcomes. The overall survival of critically ill patients receiving fosfomycin was 55%. How to cite this article Zirpe KG, Mehta Y, Pandit R, Pande R, Deshmukh AM, Patil S, et al. A Real-world Study on Prescription Pattern of Fosfomycin in Critical Care Patients. Indian J Crit Care Med 2021;25(9):1055–1058.
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Affiliation(s)
- Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Yatin Mehta
- Institute of Critical Care and Anesthesia, Medanta-The Medicity, Gurugram, Haryana, India
| | - Rahul Pandit
- Department of Intensive Care, Fortis, Mumbai, Maharashtra, India
| | - Rajesh Pande
- Department of Critical Care Medicine, BLK Super Speciality Hospital, Delhi, India
| | - Abhijit M Deshmukh
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Saiprasad Patil
- Department of Global Medical Affairs, Glenmark Pharmaceutical Ltd, Mumbai, Maharashtra, India
| | - Sagar Bhagat
- Glenmark Pharmaceutical Ltd, Mumbai, Maharashtra, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceutical Ltd, Mumbai, Maharashtra, India
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Saeed NK, Al Khawaja S, Al-Biltagi M. Antimicrobial Susceptibilities of Urinary Extended-spectrum β-lactamase Escherichia coli to Fosfomycin. Oman Med J 2021. [PMID: 34804597 DOI: 10.5001/omj.2021.95.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives Escherichia coli (E. coli)-induced urinary tract infection (UTI) is a common infection associated with frequent use of antibiotics and the increase in global antibiotic resistances. We aimed to determine the susceptibility profile of extended-spectrum β-lactamase (ESBL) producing E. coli isolated from the urinary samples to fosfomycin and other antibiotics. Methods We retrospectively analyzed urine samples with ESBL-producing E. coli isolates obtained between January 2018 and December 2019 in the Microbiology Section, Salmaniya Medical Complex, Bahrain. We collected and analyzed all the E. coli urinary isolates' data and their antibiotic susceptibility patterns. Results The study included 3044 E. coli isolates with 50.6% obtained in 2018 and 49.4% in 2019; 38.1% (1161 isolates) were ESBL E. coli, and 0.7% (21 isolates) were carbapenem-resistant Enterobacteriaceae (CRE). There were 1161 (38.1%) isolates with ESBL-producing E. coli, with 37.3% isolated in 2018 and 39.0% isolated in 2019. The antibiotic susceptibility of ESBL-producing E. coli during the study period showed susceptibility to trimethoprim/sulfamethoxazole in 46.1% of isolates (50.2% in 2018 dropped to 41.9% in 2019), to ciprofloxacin in 49.0% of isolates (49.5% in 2018 dropped to 48.4% in 2019), to nitrofurantoin in 91.8% of isolates (94.3 in 2018 dropped to 89.3% in 2019), and to fosfomycin in 97.6% of isolates (98.8% in 2018 dropped to 96.3% in 2019). Conclusions ESBL-producing E. coli is an important cause of UTI in Bahrain. Fosfomycin is a very effective oral antimicrobial that retains high efficacy against ESBL-producing E. coli, which helps decrease the need for parenteral therapy and, consequently, hospitalization.
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Affiliation(s)
- Nermin Kamal Saeed
- Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama, Bahrain
| | - Safaa Al Khawaja
- Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Bahrain
| | - Mohammed Al-Biltagi
- Pediatrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Pediatrics Department, University Medical Center, King Abdullah Medical City, Arabian Gulf University, Manama, Bahrain
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Saeed NK, Al Khawaja S, Al-Biltagi M. Antimicrobial Susceptibilities of Urinary Extended-spectrum β-lactamase Escherichia coli to Fosfomycin. Oman Med J 2021; 36:e314. [PMID: 34804597 PMCID: PMC8581151 DOI: 10.5001/omj.2021.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/09/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Escherichia coli (E. coli)-induced urinary tract infection (UTI) is a common infection associated with frequent use of antibiotics and the increase in global antibiotic resistances. We aimed to determine the susceptibility profile of extended-spectrum β-lactamase (ESBL) producing E. coli isolated from the urinary samples to fosfomycin and other antibiotics. METHODS We retrospectively analyzed urine samples with ESBL-producing E. coli isolates obtained between January 2018 and December 2019 in the Microbiology Section, Salmaniya Medical Complex, Bahrain. We collected and analyzed all the E. coli urinary isolates' data and their antibiotic susceptibility patterns. RESULTS The study included 3044 E. coli isolates with 50.6% obtained in 2018 and 49.4% in 2019; 38.1% (1161 isolates) were ESBL E. coli, and 0.7% (21 isolates) were carbapenem-resistant Enterobacteriaceae (CRE). There were 1161 (38.1%) isolates with ESBL-producing E. coli, with 37.3% isolated in 2018 and 39.0% isolated in 2019. The antibiotic susceptibility of ESBL-producing E. coli during the study period showed susceptibility to trimethoprim/sulfamethoxazole in 46.1% of isolates (50.2% in 2018 dropped to 41.9% in 2019), to ciprofloxacin in 49.0% of isolates (49.5% in 2018 dropped to 48.4% in 2019), to nitrofurantoin in 91.8% of isolates (94.3 in 2018 dropped to 89.3% in 2019), and to fosfomycin in 97.6% of isolates (98.8% in 2018 dropped to 96.3% in 2019). CONCLUSIONS ESBL-producing E. coli is an important cause of UTI in Bahrain. Fosfomycin is a very effective oral antimicrobial that retains high efficacy against ESBL-producing E. coli, which helps decrease the need for parenteral therapy and, consequently, hospitalization.
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Affiliation(s)
- Nermin Kamal Saeed
- Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama, Bahrain
| | - Safaa Al Khawaja
- Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Bahrain
| | - Mohammed Al-Biltagi
- Pediatrics Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Pediatrics Department, University Medical Center, King Abdullah Medical City, Arabian Gulf University, Manama, Bahrain
- Corresponding author: *
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Predisposition of Blood group Non-secretors to Urinary tract infection with Escherichia coli Anti-microbial Resistance and Acute Kidney Injury. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.4.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Urinary tract infection (UTI) causes significant renal damage and disease severity is compounded by antimicrobial resistance (AMR) and other comorbidities in the patient. Blood group antigens secreted in body fluids (secretor status) are known to play a role in bacterial adhesion and we studied its influence on AMR in UTI. A total of 2758 patients with UTI were studied with urine culture, qualitative and semiquantitative urine microscopy, serum creatinine and secretor status in saliva samples by adsorption-inhibition method. Of these, AMR from 300 patients with E. coli infection were assessed as per CLSI 2019 guidelines and extended-spectrum beta-lactamase (ESBL) genes (bla TEM, bla CTX-M, bla SHV) and NDM1 genes were studied using TaqMan probes in Real-time polymerase chain reaction. Patients with UTI were followed up for two weeks. Female patients had higher predilection (57%) for E. coli infection while patients with diabetes or non-secretors had none. In our study, ESBL producers were seen in 62% of the E. coli isolates and fosfomycin had 100% susceptibility. Non-secretors were significantly associated with acute kidney injury (AKI), AMR and ESBL genes. Multidrug-resistance (MDR) was noted in 127/160 (79.4%) ESBL and 17/18 (94%) NDM1 gene encoding strains. Quantitative urine microscopy scoring predicted AKI both at presentation and at end of follow up. ESBL producers were common in our study population and non-secretors had a significant association with AMR genes. Urine microscopy scoring system may be a useful tool to predict AKI in patients with UTI.
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Thiagarajan S, Stephen S, Kanagamuthu S, Ambroise S, Viswanathan P, Chinnakali P, Ganesh RN. Predisposition of Blood group Non-secretors to Urinary tract infection with Escherichia coli Anti-microbial Resistance and Acute Kidney Injury. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: https://doi.org/10.22207/jpam.15.4.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Urinary tract infection (UTI) causes significant renal damage and disease severity is compounded by antimicrobial resistance (AMR) and other comorbidities in the patient. Blood group antigens secreted in body fluids (secretor status) are known to play a role in bacterial adhesion and we studied its influence on AMR in UTI. A total of 2758 patients with UTI were studied with urine culture, qualitative and semiquantitative urine microscopy, serum creatinine and secretor status in saliva samples by adsorption-inhibition method. Of these, AMR from 300 patients with E. coli infection were assessed as per CLSI 2019 guidelines and extended-spectrum beta-lactamase (ESBL) genes (bla TEM, bla CTX-M, bla SHV) and NDM1 genes were studied using TaqMan probes in Real-time polymerase chain reaction. Patients with UTI were followed up for two weeks. Female patients had higher predilection (57%) for E. coli infection while patients with diabetes or non-secretors had none. In our study, ESBL producers were seen in 62% of the E. coli isolates and fosfomycin had 100% susceptibility. Non-secretors were significantly associated with acute kidney injury (AKI), AMR and ESBL genes. Multidrug-resistance (MDR) was noted in 127/160 (79.4%) ESBL and 17/18 (94%) NDM1 gene encoding strains. Quantitative urine microscopy scoring predicted AKI both at presentation and at end of follow up. ESBL producers were common in our study population and non-secretors had a significant association with AMR genes. Urine microscopy scoring system may be a useful tool to predict AKI in patients with UTI.
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Mothibi LM, Bosman NN, Nana T. Fosfomycin susceptibility of uropathogens at Charlotte Maxeke Johannesburg Academic Hospital. S Afr J Infect Dis 2021; 35:173. [PMID: 34485478 PMCID: PMC8377994 DOI: 10.4102/sajid.v35i1.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/13/2020] [Indexed: 01/09/2023] Open
Abstract
Background Multidrug-resistant uropathogens are becoming widespread both in community and hospital setting. Safe yet effective treatments are a priority. Fosfomycin is an antibacterial that displays good activity against most bacteria causing urinary tract infections (UTIs), including multidrug-resistant bacteria. The aim of this study was to evaluate fosfomycin susceptibility for uropathogens isolated from a microbiology laboratory at a tertiary academic hospital. In addition, this was compared to the susceptibility of other oral antimicrobials. Methods We conducted a retrospective analysis of laboratory reports for uropathogens isolated at Charlotte Maxeke Johannesburg Academic Hospital from September 2015 to August 2017. Antimicrobial susceptibility testing of the isolates was performed using the Kirby–Bauer disk diffusion method or the Vitek® 2 system according to the Clinical and Laboratory Standards Institute. Results Overall susceptibility of fosfomycin for the 4700 Enterobacteriaceae isolates was 95.7%; 95% confidence interval (CI) 95.1–96.2. The overall susceptibility for fosfomycin against the gram-positives was 98.6%. There were 37.9% multidrug-resistant Enterobacteriaceae (MDRE) isolated during the study period. Fosfomycin displayed activity against 94.4% of extended-spectrum β-lactamase (ESBL) producers and 90.7% for carbapenem-resistant Enterobacteriaceae (CRE). None of the methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus isolates tested was fosfomycin resistant. The overall in vitro susceptibility was significantly higher for fosfomycin (p = 0.0001) compared to amoxicillin/clavulanic acid, cephalexin, cefuroxime, ciprofloxacin, trimethoprim/sulfamethoxazole and nitrofurantoin. Conclusion This study confirmed the high susceptibility of fosfomycin against UTI pathogens isolated at our institution. In an era of increasing antimicrobial resistance, fosfomycin represents a potential option for the treatment of UTIs at Charlotte Maxeke Johannesburg Academic Hospital.
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Affiliation(s)
- Lesego M Mothibi
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Parktown, South Africa.,National Health Laboratory Services, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Norma N Bosman
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Parktown, South Africa.,National Health Laboratory Services, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Trusha Nana
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Parktown, South Africa.,National Health Laboratory Services, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Guzmán Ramos PJ, Shiel RE, Fernández Pérez C, Ríos Boeta AM, Perlado Chamizo MR, Ballester Aguado JI, Ruiz Duro N, Ortiz-Díez G. Antimicrobial resistance increased over an 8-year period in Enterobacteriaceae cultured from canine urine samples. J Small Anim Pract 2021; 62:279-285. [PMID: 33460135 DOI: 10.1111/jsap.13291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/06/2020] [Accepted: 11/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the present study were to describe the prevalence of positive urinary bacterial culture in dogs, to identify the most commonly isolated microorganisms and to analyse changes in antimicrobial susceptibility patterns over time. MATERIAL AND METHODS A retrospective case series was performed using culture and susceptibility results from canine urine samples collected between January 2010 and December 2017. The presence or absence of infection, identity of the bacterium with heaviest growth, and susceptibility profile were recorded for each sample. Trends in the frequency of positive culture and antimicrobial resistance were assessed by Poisson regression modelling. Prevalence rate ratio and 95% confidence interval were reported for resistance to each antimicrobial. RESULTS A positive urine culture was documented in 771 (22.5%) of 3420 samples. Escherichia coli was the most commonly isolated microorganism. There was no significant increase in the frequency of positive bacterial culture over the study period (prevalence rate ratio 0.98; 95% confidence interval: 0.92 to 1.0). Overall, there was an increase in antimicrobial resistance within Enterobacteriaceae from 5.2 to 35.6%. The prevalence of multidrug-resistant bacteria varied from year to year throughout the study period. However, the Poisson regression model identified a significant increase in the frequency of multidrug-resistant Enterobacteriaceae over this period, averaging approximately 22% per year (prevalence rate ratio 1.22, 95% confidence interval: 1.06 to 1.42). CLINICAL SIGNIFICANCE The significant increase in antimicrobial resistance observed in this study is concerning and may have implications for veterinary and public health. Appropriate measures, such as antibiotic stewardship programmes, should be implemented to address increasing antimicrobial resistance.
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Affiliation(s)
- P J Guzmán Ramos
- School of Veterinary Medicine, College of Health and Agricultural Sciences, University College Dublin, Dublin, Belfield, Dublin 4, Ireland
| | - R E Shiel
- School of Veterinary Medicine, College of Health and Agricultural Sciences, University College Dublin, Dublin, Belfield, Dublin 4, Ireland
| | - C Fernández Pérez
- Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria (IsDSSS), Hospital Clínico San CarlosCalle del Prof. Martín Lagos, Madrid, 28040, Spain
| | - A M Ríos Boeta
- Hospital Veterinario PucholCalle Sauceda 8, Madrid, 28050, Spain
| | - M R Perlado Chamizo
- Hospital Clínico Veterinario, Universidad Alfonso X el SabioAvenida de la Universidad, 1, Madrid, 28691, Spain
| | - J I Ballester Aguado
- Hospital Clínico Veterinario, Universidad Alfonso X el SabioAvenida de la Universidad, 1, Madrid, 28691, Spain
| | - N Ruiz Duro
- Hospital Clínico Veterinario, Universidad Alfonso X el SabioAvenida de la Universidad, 1, Madrid, 28691, Spain
| | - G Ortiz-Díez
- Hospital Clínico Veterinario, Universidad Alfonso X el SabioAvenida de la Universidad, 1, Madrid, 28691, Spain
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11
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K S S, Pallam G, Mandal J, Jindal B, S K. Use of fosfomycin combination therapy to treat multidrug-resistant urinary tract infection among paediatric surgical patients - a tertiary care centre experience. Access Microbiol 2020; 2:acmi000163. [PMID: 33195977 PMCID: PMC7660243 DOI: 10.1099/acmi.0.000163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022] Open
Abstract
With increasing resistance to currently used antibiotics, antibiotic combinations are being resorted to. The present study deals with five children with complicated urinary tract infection (UTI) whose urine cultures grew multidrug-resistant (MDR) organisms. In all of these five cases, MDR organisms were the causative agents for UTI and the currently available antibiotics, including colistin, were ineffective, although the organisms were sensitive in vitro. In all of these cases, the isolates reverted to being susceptible to the quinolones and cephalosporins tested, namely ceftriaxone and ceftazidime. All were treated using a combination of fosfomycin with other antibiotics, since it has no interference with other classes of antibiotics. Our observations suggest that the use of a combination of fosfomycin with either a carbapenem or an aminoglycoside in a clinical setting would be a reasonable choice to treat UTIs caused by MDR organisms, especially in complicated cases that require chronic therapy.
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Affiliation(s)
- Shiju K S
- Department of Pediatric Surgery, JIPMER, Puducherry, India
| | | | - Jharna Mandal
- Department of Microbiology, JIPMER, Puducherry, India
| | | | - Kumaravel S
- Department of Pediatric Surgery, JIPMER, Puducherry, India
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12
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Singkham-in U, Muhummudaree N, Chatsuwan T. fosA3 overexpression with transporter mutations mediates high-level of fosfomycin resistance and silence of fosA3 in fosfomycin-susceptible Klebsiella pneumoniae producing carbapenemase clinical isolates. PLoS One 2020; 15:e0237474. [PMID: 32857767 PMCID: PMC7454978 DOI: 10.1371/journal.pone.0237474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/27/2020] [Indexed: 12/04/2022] Open
Abstract
The effective treatment of carbapenemase-producing Klebsiella pneumoniae infection has been limited and required novel potential agents. Due to the novel drug development crisis, using old antimicrobial agents and combination therapy have been highlighted. This study focused on fosfomycin which inhibits cell wall synthesis and has potential activity on Enterobacteriaceae. We evaluated fosfomycin activity against carbapenemase-producing K. pneumoniae and characterized fosfomycin resistance mechanisms. Fosfomycin revealed effective activity against only 31.8% of carbapenemase-producing K. pneumoniae isolates. The major resistance mechanism was FosA3 production. The co-occurrence of FosA3 overexpression with the mutation of glpT (or loss of glpT) and/or uhpT was mediated high-level resistance (MIC>256 mg/L) to fosfomycin. Moreover, fosA3 silenced in sixteen fosfomycin-susceptible isolates and the plasmid carrying fosA3 of these isolates increased 32- to 64-fold of fosfomycin MICs in Escherichia coli DH5α transformants. The in vitro activity of fosfomycin combination with amikacin by checkerboard assay showed synergism and no interaction in six (16.2%) and sixteen isolates (43.3%), respectively. No antagonism of fosfomycin and amikacin was observed. Notably, the silence of aac (6)’-Ib and aphA6 was observed in amikacin-susceptible isolates. Our study suggests that the combination of fosfomycin and amikacin may be insufficient for the treatment of carbapenemase-producing K. pneumoniae isolates.
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Affiliation(s)
- Uthaibhorn Singkham-in
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Netchanok Muhummudaree
- Interdisciplinary Program of Medical Microbiology, Graduate School, Chulalongkorn University, Bangkok, Thailand
| | - Tanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
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13
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Fajfr M, Balik M, Cermakova E, Bostik P. Effective Treatment for Uncomplicated Urinary Tract Infections with Oral Fosfomycin, Single Center Four Year Retrospective Study. Antibiotics (Basel) 2020; 9:antibiotics9080511. [PMID: 32823650 PMCID: PMC7459894 DOI: 10.3390/antibiotics9080511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 07/31/2020] [Accepted: 08/11/2020] [Indexed: 12/19/2022] Open
Abstract
Fosfomycin represents a relatively old antibiotic, but it is experiencing a comeback in recent years. According to some studies, the increasing therapeutic use of this drug led to a rapid increase in the levels of resistance in bacteria causing urinary tract infection. In the presented study, levels of resistance to fosfomycin in more than 3500 bacterial isolates before and after fosfomycin introduction into therapeutic use in the Czech Republic and the clinical efficacy of treatment in 300 patients using this drug were assessed. The results show that the resistance levels to fosfomycin in Escherichia coli isolates before and after the drug registration were not significantly different (3.4% and 4.4%, respectively). In some other Gram-negative rods, such as otherwise susceptible Enterobacter, resistance to fosfomycin increased significantly from 45.6% to 76.6%. Fosfomycin treatment of urinary tract infections showed an excellent seven-day clinical efficacy (79.7%). However, when used to treat recurrent or complicated urinary tract infections, fosfomycin treatment was associated with high levels of infection relapse, leading to relapse in a total of 20.4% of patients during the first two months. This indicates that fosfomycin exhibits good efficacy only for the treatment of uncomplicated urinary tract infections
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Affiliation(s)
- Miroslav Fajfr
- Institute of Clinical Microbiology, University Hospital, Sokolska 581, 500 05 Hradec Kralove, Czech Republic;
- Faculty of Medicine in Hradec Kralove, Charles University in Prague, Simkova 870, 500 38 Hradec Kralove, Czech Republic;
| | - Michal Balik
- Faculty of Medicine in Hradec Kralove, Charles University in Prague, Simkova 870, 500 38 Hradec Kralove, Czech Republic;
- Department of Urology, University Hospital, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
| | - Eva Cermakova
- Faculty of Medicine in Hradec Kralove, Department of Medical Biophysics, Charles University in Prague, Simkova 870, 500 38 Hradec Kralove, Czech Republic;
| | - Pavel Bostik
- Institute of Clinical Microbiology, University Hospital, Sokolska 581, 500 05 Hradec Kralove, Czech Republic;
- Faculty of Medicine in Hradec Kralove, Charles University in Prague, Simkova 870, 500 38 Hradec Kralove, Czech Republic;
- Faculty of Military Health Sciences, University of Defence, Trebesska 1575, 500 01 Hradec Kralove, Czech Republic
- Correspondence: ; Tel.: +420-724-692-609
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14
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Kwan ACF, Beahm NP. Fosfomycin for bacterial prostatitis: a review. Int J Antimicrob Agents 2020; 56:106106. [PMID: 32721595 DOI: 10.1016/j.ijantimicag.2020.106106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 11/25/2022]
Abstract
There has been growing interest in fosfomycin for the treatment of bacterial prostatitis due to evidence suggesting that it achieves adequate prostatic concentrations for antimicrobial effect, has activity against resistant micro-organisms, and has a low-toxicity profile. This review evaluated the current clinical evidence for fosfomycin in acute and chronic bacterial prostatitis to elucidate the clinical implications of fosfomycin in an era of increasing antimicrobial resistance. PubMed, Scopus, EMBASE, Web of Science, Google Scholar and ClinicalTrials.gov were searched for studies published in the English language from January 1984 to November 2019. The inclusion criteria were met if the study reported the use of fosfomycin (more than one dose) to treat bacterial prostatitis. Ten observational studies were identified that met the inclusion criteria. The evidence for the use of fosfomycin in acute bacterial prostatitis is sparse. The majority of the available evidence is for chronic bacterial prostatitis caused by Escherichia coli. Despite the implementation of variable dosing regimens, extended courses of fosfomycin appear to be safe and effective in achieving clinical and microbiological cure. In these studies, the use of fosfomycin was restricted to cases of treatment failure, intolerance to first-line therapy, or multi-resistant organisms. However, given the development of resistant organisms and the undesirable adverse effects of many first-line therapeutic options, fosfomycin has the potential to be considered as an effective first-line alternative for acute and chronic bacterial prostatitis in the future. Further studies, including randomized controlled trials, would be helpful to firmly establish its optimal dosing regimen, efficacy and place in therapy.
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Affiliation(s)
- Alex C F Kwan
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada T6G 1C9
| | - Nathan P Beahm
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada T6G 1C9.
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15
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Antimicrobial Susceptibility and Cross-Resistance Patterns among Common Complicated Urinary Tract Infections in U.S. Hospitals, 2013 to 2018. Antimicrob Agents Chemother 2020; 64:AAC.00346-20. [PMID: 32423953 DOI: 10.1128/aac.00346-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/26/2020] [Indexed: 01/09/2023] Open
Abstract
In the face of increasing rates of antimicrobial resistance in complicated urinary tract infections (cUTIs), clinicians need to understand cross-resistance patterns among commonly encountered pathogens. We performed a multicenter, retrospective cohort study in the Premier database of approximately 180 hospitals, from 2013 to 2018. Using an ICD-9/10-based algorithm, we identified all adult patients hospitalized with cUTIs and included those with a positive blood or urine culture. We examined the microbiology and susceptibilities to common cUTI antimicrobials (3rd-generation cephalosporin [C3], fluoroquinolones [FQ], trimethoprim-sulfamethoxazole [TMP/SMZ], fosfomycin [FFM], and nitrofurantoin [NFT]) singly and in groups of two. Among 28,057 organisms from 23,331 patients, the 3 most common pathogens were Escherichia coli (41.0%; C3r, 15.1%), Klebsiella pneumoniae (12.1%; C3r, 13.2%), and Pseudomonas aeruginosa (11.0%; C3r, 12.0%). E. coli was most frequently resistant to FQ (43.5%) and least to NFT (6.7%). K. pneumoniae was most frequently resistant to NFT (60.8%) and least to FFM (0.1%). P. aeruginosa was most frequently resistant to FQ (34.4%) and least to TMP/SMZ (4.2%). Of the C3r E. coli isolates, 87.1% were also FQr, 63.7% were TMP/SMZr, and 13.3% were NFTr C3r K. pneumoniae isolates had a 76.5% chance of being FQr, 78.1% were TMP/SMZr, and 77.6% were NFTr C3r P. aeruginosa coexisted with FQr in 47.3%, TMP/SMZr in 18.9%, and NFTr in 28.7%. Among the most common pathogens isolated from hospitalized patients with cUTIs, the rates of single resistance to common treatments and of cross-resistance to these regimens are substantial. Knowing the patterns of cross-resistance may help clinicians tailor empirical therapy more precisely.
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16
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Abdelhady ASM, Darwish NM, Abdel-Rahman SM, Abo El Magd NM. The combined antimicrobial activity of citrus honey and fosfomycin on multidrug resistant Pseudomonas aeruginosa isolates. AIMS Microbiol 2020; 6:162-175. [PMID: 32617448 PMCID: PMC7326728 DOI: 10.3934/microbiol.2020011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022] Open
Abstract
Infections with Pseudomonas aeruginosa (P. aeruginosa) have become a real fear in hospital-acquired infections, especially in critically ill and immunocompromised patients. Thus, advance of novel anti-infectives is currently pursued. The aim of the present study was to evaluate the antibacterial effect of each of citrus honey and fosfomycin in comparison to the combined effect of both of them on multidrug resistant (MDR) P. aeruginosa. 50 MDR P. aeruginosa isolates were tested for the antibacterial effect of citrus honey. Screening for potential synergistic activity of fosfomycin and honey combinations by E test. Molecular detection of the virulent exoenzyme U (exoU) genotype by conventional PCR was done. The present study found that 50 % (v/v) concentration of citrus honey was sufficient to inhibit the growth of most isolates (33/50, 66%). Minimal inhibitory concentration (MIC) for fosfomycin tested by E test was found to be >128 µg/mL in 50(100%) of MDR P. aeruginosa isolates but after repeating E test with Mueller-Hinton agar (MHA) containing sublethal concentration of citrus honey (29/50,58%) isolates were sensitive. Also, there was a significant correlation between the presence of exoU gene and positive synergy of citrus honey-fosfomycin combination. This study showed that citrus honey has antibacterial effect and synergy with fosfomycin antibiotic against MDR P. aeruginosa isolates. Also, exoU positive genotype is associated with MDR phenotype. In conclusion, our results revealed that the citrus honey-fosfomycin combination showed highly statistically significant effect on MDR P. aeruginosa fosfomycin susceptibility pattern. exoU positive P. aeruginosa isolates were detected mostly in burn unit and ICUs. Also, there was a statistically significant correlation between the presence of exoU gene and positive result of honey-fosfomycin combination E test.
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Affiliation(s)
- Amira Saied M Abdelhady
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nebal Medhat Darwish
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Safaa M Abdel-Rahman
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nagwa M Abo El Magd
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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17
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Batra P, Abrol AK, Gupta S, Pushpan P, Kumar R. Susceptibility pattern of oral antimicrobials in uncomplicated UTI: Does fosfomycin still stand effective? J Family Med Prim Care 2020; 9:850-853. [PMID: 32318433 PMCID: PMC7113987 DOI: 10.4103/jfmpc.jfmpc_970_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 12/20/2019] [Accepted: 12/31/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Urinary tract infections (UTIs) are a leading cause of morbidity amongst all age groups and most patients with uncomplicated UTI who visit the OPD are treated with empirical antibiotics without doing any culture analysis. Of all the oral antibiotics used in UTI, fosfomycin is well excreted in the urine and is being used for the treatment of UTIs with a single oral dose. METHODOLOGY The current study was planned to determine the resistance amongst uropathogens to various oral antibiotics including fosfomycin isolated over a 4-year period (April 2015 to March 2019). RESULTS A total of 22,546 urine samples were received from OPD patients over 4 years and of these, 7,295 isolates were obtained from patients with uncomplicated UTI. About 82% of the isolates were gram-negative bacilli (GNBs). The most common isolate was E. coli 1023 (67.2%) followed by Klebsiella spp 254 (16.7%), and Pseudomonas spp 63 (4.1%). Of all the antibiotics tested, maximum sensitivity in the year 2018 was found to fosfomycin followed by nitrofurantoin for all the isolates tested. There was a statistically significant increase in the resistance pattern for almost all antibiotics tested in gram-negative bacteria (both Enterobacteriaceae and nil fermenters) whereas the increase in the resistance was not statistically significant in gram-positive cocci. CONCLUSION It can be easily seen that the level of antibiotic resistance has been increasing even in the community with the rampant injudicious use of antibiotics in humans as well as livestock. As the level of resistance to fosfomycin is still low in the community, it can play a promising role in the treatment of infection in patients with uncomplicated UTI.
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Affiliation(s)
- Priyam Batra
- Department of Lab Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Amit K Abrol
- Department of Lab Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Stuti Gupta
- Department of Lab Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Preeti Pushpan
- Department of Lab Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajendra Kumar
- Department of Lab Medicine, All India Institute of Medical Sciences, New Delhi, India
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18
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López-Medrano F, Silva JT, Fernández-Ruiz M, Vidal E, Origüen J, Calvo-Cano A, Luna-Huerta E, Merino E, Hernández D, Jironda-Gallegos C, Escudero R, Gioia F, Moreno A, Roca C, Cordero E, Janeiro D, Sánchez-Sobrino B, Montero MM, Redondo D, Candel FJ, Pérez-Flores I, Armiñanzas C, González-Rico C, Fariñas MC, Rodrigo E, Loeches B, López-Oliva MO, Montejo M, Lauzurica R, Horcajada JP, Pascual J, Andrés A, Aguado JM. Oral fosfomycin for the treatment of lower urinary tract infections among kidney transplant recipients-Results of a Spanish multicenter cohort. Am J Transplant 2020; 20:451-462. [PMID: 31550408 DOI: 10.1111/ajt.15614] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/08/2019] [Accepted: 09/12/2019] [Indexed: 01/25/2023]
Abstract
Oral fosfomycin may constitute an alternative for the treatment of lower urinary tract infections (UTIs) in kidney transplant recipients (KTRs), particularly in view of recent safety concerns with fluroquinolones. Specific data on the efficacy and safety of fosfomycin in KTR are scarce. We performed a retrospective study in 14 Spanish hospitals including KTRs treated with oral fosfomycin (calcium and trometamol salts) for posttransplant cystitis between January 2005 and December 2017. A total of 133 KTRs developed 143 episodes of cystitis. Most episodes (131 [91.6%]) were produced by gram-negative bacilli (GNB), and 78 (54.5%) were categorized as multidrug resistant (including extended-spectrum β-lactamase-producing Enterobacteriaceae [14%] or carbapenem-resistant GNB [3.5%]). A median daily dose of 1.5 g of fosfomycin (interquartile range [IQR]: 1.5-2) was administered for a median of 7 days (IQR: 3-10). Clinical cure (remission of UTI-attributable symptoms at the end of therapy) was achieved in 83.9% (120/143) episodes. Among those episodes with follow-up urine culture, microbiological cure at month 1 was achieved in 70.2% (59/84) episodes. Percutaneous nephrostomy was associated with a lower probability of clinical cure (adjusted odds ratio: 10.50; 95% confidence interval: 0.98-112.29; P = 0.052). In conclusion, fosfomycin is an effective orally available alternative for treating cystitis among KTRs.
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Affiliation(s)
- Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital, "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - José Tiago Silva
- Unit of Infectious Diseases, University Hospital, "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital, "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Elisa Vidal
- Unit of Infectious Diseases, University Hospital "Reina Sofía", Instituto Maimónides de Investigación en Biomedicina de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | - Julia Origüen
- Unit of Infectious Diseases, University Hospital, "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Antonia Calvo-Cano
- Department of Infectious Diseases, University Hospital of Badajoz, Badajoz, Spain
| | | | - Esperanza Merino
- Unit of Infectious Diseases, General University Hospital of Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Domingo Hernández
- Department of Nephrology, Regional University Hospital "Carlos Haya", Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Cristina Jironda-Gallegos
- Department of Nephrology, Regional University Hospital "Carlos Haya", Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain
| | - Rosa Escudero
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Francesca Gioia
- Department of Infectious Diseases, University Hospital "Ramón y Cajal", Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Antonio Moreno
- Department of Infectious Diseases, University Hospitals "Virgen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Cristina Roca
- Department of Infectious Diseases, University Hospitals "Virgen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Elisa Cordero
- Department of Infectious Diseases, University Hospitals "Virgen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Darío Janeiro
- Department of Nephrology, University Hospital Puerta de Hierro-Majadahonda, Investigación Sanitaria Puerta de Hierro "Segovia de Arana", Majadahonda, Spain
| | - Beatriz Sánchez-Sobrino
- Department of Nephrology, University Hospital Puerta de Hierro-Majadahonda, Investigación Sanitaria Puerta de Hierro "Segovia de Arana", Majadahonda, Spain
| | - María Milagro Montero
- Department of Infectious Diseases, Hospital del Mar, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Dolores Redondo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Francisco Javier Candel
- Department of Clinical Microbiology and Infectious Diseases, Hospital Clínico Universitario "San Carlos", Instituto de Investigación Sanitaria "San Carlos" (IdISSC), Transplant Coordination Unit, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Isabel Pérez-Flores
- Department of Nephrology, Hospital Clínico Universitario "San Carlos", Instituto de Investigación Sanitaria "San Carlos" (IdISSC), School of Medicine, Universidad Complutense, Madrid, Spain
| | - Carlos Armiñanzas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Instituto de Investigación "Marqués de Valdecilla" (IDIVAL), University of Cantabria, Santander, Spain
| | - Claudia González-Rico
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Instituto de Investigación "Marqués de Valdecilla" (IDIVAL), University of Cantabria, Santander, Spain
| | - María Carmen Fariñas
- Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Instituto de Investigación "Marqués de Valdecilla" (IDIVAL), University of Cantabria, Santander, Spain
| | - Emilio Rodrigo
- Department of Nephrology, University Hospital "Marqués de Valdecilla", Instituto de Investigación "Marqués de Valdecilla" (IDIVAL), University of Cantabria, Santander, Spain
| | - Belén Loeches
- Department of Microbiology, University Hospital La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - María O López-Oliva
- Department of Nephrology, University Hospital La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Miguel Montejo
- Unit of Infectious Diseases, Hospital Universitario Cruces, Universidad del País Vasco, Barakaldo, Spain
| | - Ricardo Lauzurica
- Department of Nephrology, University Hospital "Germans Trias i Pujol", Badalona, Barcelona, Spain
| | - Juan Pablo Horcajada
- Department of Infectious Diseases, Hospital del Mar, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Amado Andrés
- Department of Nephrology, University Hospital "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, University Hospital, "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), School of Medicine, Universidad Complutense, Madrid, Spain
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19
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Das A, Banerjee T, Anupurba S. Susceptibility of Nitrofurantoin and Fosfomycin Against Outpatient Urinary Isolates of Multidrug-Resistant Enterococci over a Period of 10 Years from India. Microb Drug Resist 2019; 26:1509-1515. [PMID: 31794690 DOI: 10.1089/mdr.2019.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
With the increasing emergence of drug resistance in enterococci, there have been very limited data on the efficacy of orally available nitrofurantoin and fosfomycin on enterococci causing urinary tract infections (UTIs), particularly for multidrug-resistant (MDR) strains. This study aimed to determine the in vitro effectiveness of these two drugs against the MDR enterococci. A total of 514 phenotypically and genotypically confirmed isolates of enterococci (239, 46.5% Enterococcus faecalis and 275, 53.5% Enterococcus faecium) showed E. faecalis as significantly more resistant (p < 0.05) to ciprofloxacin and high strength gentamicin. Vancomycin resistance was seen in 37 (7.2%) isolates. Of these, 114 (22.18%) isolates (51, 44.73% E. faecalis and 63, 55.26% E. faecium) were MDR. Nitrofurantoin minimum inhibitory concentrations (MICs) for the MDR enterococci varied from 1 to 128 μg/mL (MIC50 8 μg/mL, MIC90 64 μg/mL for E. faecalis), while fosfomycin MICs for the MDR E. faecalis, including vancomycin resistant enterococci (VRE) were in susceptible range (≤64 μg/mL, MIC50 8 μg/mL, MIC90 16 μg/mL). An efficacy ratio of ≥8 for nitrofurantoin was observed in the 39 (76.5%) MDR E. faecalis and 44 (69.8%) MDR E. faecium isolates as against the 50 (98%) E. faecalis isolates for fosfomycin. Although nitrofurantoin has been widely prescribed for the treatment of UTIs for the past several years, it was still found to be active in vitro against the urinary isolates of MDR enterococci, including VRE. As for fosfomycin, it holds robust potential to be used against the urinary MDR enterococci and VRE (E. faecalis).
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Affiliation(s)
- Arghya Das
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Tuhina Banerjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shampa Anupurba
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Analysis of urine-specific antibiograms from veterans to guide empiric therapy for suspected urinary tract infection. Diagn Microbiol Infect Dis 2019; 95:114874. [PMID: 31575439 DOI: 10.1016/j.diagmicrobio.2019.114874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 11/23/2022]
Abstract
Urinary tract infection (UTI) is common among patients at Veterans Affairs Medical Centers (VAMCs), many of whom are elderly men with underlying urological problems. Most UTI guidelines address uncomplicated UTI in women, and clinicians may select empiric therapy based on local hospital-wide Escherichia coli cumulative susceptibility (antibiogram) data. To inform selection of empiric therapy for UTI at the Minneapolis VAMC (MVAMC), we compiled antimicrobial susceptibility testing (AST) results for 1 year's urine isolates. We analyzed these AST results (bioMerieux VITEK®) for 2494 microbiologically significant urine isolates at MVAMC from June 2013 through May 2014. For antimicrobial-organism combinations that were not tested, we imputed results based on local or published data and/or expert opinion. For ambiguous antimicrobial-organism combinations, we analyzed susceptibility as both 0% and 100%. We calculated cumulative percent susceptible for 26 relevant antimicrobial agents, overall and stratified by Gram stain characteristic and clinical site. The study population included 1548 Gram-negative and 946 Gram-positive urine isolates. Species distribution varied significantly by clinical site. E. coli represented only 27% of isolates overall (9-37%, depending on site); also prevalent were Enterococcus (14%) and other Gram-positive organisms (23%). Urine-specific antibiograms varied significantly by Gram stain characteristic, between E. coli and other Gram-negative organisms, and by clinical site. Of the oral agents, only fosfomycin provided ≥80% susceptibility. Ultimately, E. coli represented urine isolates poorly with respect to species distribution and AST results. We conclude that urine-specific antibiograms, stratified by Gram stain characteristic and clinical site, may improve empirical UTI therapy for veterans.
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Gopichand P, Agarwal G, Natarajan M, Mandal J, Deepanjali S, Parameswaran S, Dorairajan LN. In vitro effect of fosfomycin on multi-drug resistant gram-negative bacteria causing urinary tract infections. Infect Drug Resist 2019; 12:2005-2013. [PMID: 31372008 PMCID: PMC6628599 DOI: 10.2147/idr.s207569] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/17/2019] [Indexed: 11/23/2022] Open
Abstract
Background Rising rates of resistance to antimicrobial drugs among Enterobacteriaceae limit the choice of therapeutic agents to treat urinary tract infections. In this context we assessed the in-vitro effect of fosfomycin against extended-spectrum beta-lactamases, AmpC beta-lactamases and carbapenemase-producing strains of Escherichia coli, Klebsiella pneumoniae, Enterobacter spp, and Pseudomonas aeruginosa isolated from the patients with urinary tract infection (UTI) and also studied the effect of fosfomycin on their biofilm formation. Materials and methods A total of 326 multidrug-resistant (MDR) isolates comprising of Escherichia coli, Klebsiella pneumoniae, Enterobacter spp, and Pseudomonas aeruginosa from the urine samples of the patients with a diagnosis of UTI were included in the study. MIC 50 and MIC 90 were detected by agar dilution method and the capacity to form biofilm in the presence of fosfomycin by these MDR isolates was assessed by the tissue culture plate method. Results The MIC50 for meropenem (0.5 µgm/mL) and nitrofurantoin (32 µgm/mL) was within the susceptible range only for E. coli. Fosfomycin was the only antibiotic that inhibited 100% E.coli, 70% Klebsiella spp, and 50% Pseudomonas spp and 40% Enterobacter spp which included the extended-spectrum beta-lactamases producers. It showed a similar effect on carbapenemase producers and AmpC producers. Fosfomycin disrupted biofilm in 67% (n=141) E.coli, 74% (n=50) Klebsiella spp, 88% (n=27) Pseudomonas spp and 36% (n=23) Enterobacter spp at 24 hrs of incubation with a concentration of 2 fold dilution lower than that of the MIC. Conclusion Fosfomycin showed a good inhibitory effect on the biofilms produced by the MDR organisms studied here.
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Affiliation(s)
- Pallam Gopichand
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Girija Agarwal
- Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) , Pondicherry, India
| | - Mailan Natarajan
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Jharna Mandal
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Surendran Deepanjali
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Sreejith Parameswaran
- Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - L N Dorairajan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
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Hartmann FA, Fox L, Fox B, Viviano K. Diagnostic and therapeutic challenges for dogs with urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli. J Am Vet Med Assoc 2019; 253:850-856. [PMID: 30211649 DOI: 10.2460/javma.253.7.850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Current options for the treatment of infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae in different groups of patients. Clin Microbiol Infect 2019; 25:932-942. [PMID: 30986558 DOI: 10.1016/j.cmi.2019.03.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/27/2019] [Accepted: 03/31/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are a frequent cause of invasive infections worldwide. Carbapenems are nowadays the most used drugs to treat these infections. However, due to the increasing rates of resistance to these antimicrobials, carbapenem-sparing alternatives are being investigated. OBJECTIVES AND SOURCES The aim of this narrative literature review is to summarize the published information on the currently available antibiotics for the treatment of ESBL-E infections, providing specific information on three subgroups of patients: Group 1, patients with severe infections or infections from high-risk sources or in severely immunocompromised patients; Group 2, patients with non-severe infections from intermediate-risk source; and Group 3, patients with non-severe urinary tract infection. CONTENT AND IMPLICATIONS For patients in Group 1, the current data would support the use of carbapenems. For milder infections, however, particularly urinary tract infections, other non-carbapenem antibiotics can be considered in selected cases, including beta-lactam/beta-lactam inhibitor combinations, cephamycins, temocillin and aminoglycosides. While specific studies should be performed in these situations, individualized decisions may be taken in order to avoid overuse of carbapenems.
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Cottell JL, Webber MA. Experiences in fosfomycin susceptibility testing and resistance mechanism determination in Escherichia coli from urinary tract infections in the UK. J Med Microbiol 2019; 68:161-168. [DOI: 10.1099/jmm.0.000901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Jennifer L. Cottell
- 1Department of Microbiology, Northampton General Hospital NHS Trust, Cliftonville, Northampton NN1 5BD, UK
- 2Quadram Institute, Norwich Research Park, Colney Lane, Norwich, NR4 7UA, UK
- †Present address: Micropathology Ltd, University of Warwick Science Park, Venture Centre, Sir William Lyons Road, Coventry CV4 7EZ, UK
| | - Mark A. Webber
- 2Quadram Institute, Norwich Research Park, Colney Lane, Norwich, NR4 7UA, UK
- 3Norwich Medical School, Norwich Research Park, Colney Lane, Norwich NR4 7TJ, UK
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Aghamali M, Sedighi M, Zahedi Bialvaei A, Mohammadzadeh N, Abbasian S, Ghafouri Z, Kouhsari E. Fosfomycin: mechanisms and the increasing prevalence of resistance. J Med Microbiol 2019; 68:11-25. [PMID: 30431421 DOI: 10.1099/jmm.0.000874] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
There are challenges regarding increased global rates of microbial resistance and the emergence of new mechanisms that result in microorganisms becoming resistant to antimicrobial drugs. Fosfomycin is a broad-spectrum bactericidal antibiotic effective against Gram-negative and certain Gram-positive bacteria, such as Staphylococci, that interfere with cell wall synthesis. During the last 40 years, fosfomycin has been evaluated in a wide range of applications and fields. Although numerous studies have been done in this area, there remains limited information regarding the prevalence of resistance. Therefore, in this review, we focus on the available data concerning the mechanisms and increasing resistance regarding fosfomycin.
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Affiliation(s)
- Mina Aghamali
- 1Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mansour Sedighi
- 2Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abed Zahedi Bialvaei
- 2Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nima Mohammadzadeh
- 2Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Abbasian
- 2Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghafouri
- 3Department of Biochemistry, Biophysics and Genetics, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ebrahim Kouhsari
- 2Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Khilnani, GC, Zirpe, K, Hadda, V, Mehta, Y, Madan, K, Kulkarni, A, Mohan, A, Dixit, S, Guleria, R, Bhattacharya, P. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian J Crit Care Med 2019; 23:S1-S63. [PMID: 31516211 PMCID: PMC6734471 DOI: 10.5005/jp-journals-10071-23101] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
How to cite this article: Khilnani GC, Zirpe K, Hadda V, Mehta Y, Madan K, Kulkarni A, Mohan A, Dixit S, Guleria R, Bhattacharya P. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian Journal of Critical Care Medicine 2019;23 (Suppl 1):1-63.
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Affiliation(s)
- GC Khilnani,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Zirpe,
- Neuro-Trauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Vijay Hadda,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Yatin Mehta,
- Indian Society of Critical Care Medicine, Medanta Institute of Critical Care and Anesthesiology, Gurugram, Haryana, India
| | - Karan Madan,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kulkarni,
- Department of Anaesthesiology, Division of Critical Care Medicine, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anant Mohan,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Subhal Dixit,
- Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Randeep Guleria,
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Bhattacharya,
- Department of Anaesthesiology, Critical Care and Emergency Services, Bhopal, Madhya Pradesh, India
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Gonzalez Moreno M, Trampuz A, Di Luca M. Synergistic antibiotic activity against planktonic and biofilm-embedded Streptococcus agalactiae, Streptococcus pyogenes and Streptococcus oralis. J Antimicrob Chemother 2018; 72:3085-3092. [PMID: 28961884 DOI: 10.1093/jac/dkx265] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/04/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives To determine the antimicrobial activity against streptococcal biofilm in species mostly isolated from implant-associated infections and examine the effect of enzyme treatment of biofilm on the antimicrobial activity of different antibiotics. Methods The activities of fosfomycin, rifampicin, benzylpenicillin, daptomycin, gentamicin, levofloxacin, proteinase K and their combinations on planktonic and/or biofilm-embedded standard laboratory strains of Streptococcus agalactiae, Streptococcus pyogenes and Streptococcus oralis were investigated in vitro by standard methods and isothermal microcalorimetry. Results MIC values obtained for the tested antimicrobials against planktonic bacteria ranged from 0.016 to 128 mg/L for the three species tested. Higher antibiotic concentrations were usually required to reduce biofilm in comparison with planktonic bacteria, with the exception of gentamicin, for which similar concentrations (4-16 mg/L) exerted an effect on both planktonic and biofilm cells. A synergistic effect against the streptococcal biofilm of the three species was observed when gentamicin was combined with benzylpenicillin or with rifampicin. Moreover, antibiotic concentrations comparable to the MIC observed against planktonic cells induced a strong reduction of viable bacteria in proteinase K pre-treated biofilm. Conclusions This study shows that the combination of gentamicin with either benzylpenicillin or rifampicin exerts a synergistic effect against biofilms produced by the tested streptococci strains in vitro. Our results also suggest that coupling a dispersal agent with conventional antibiotics may facilitate their access to the bacteria within the biofilm. In vivo and clinical studies are needed in order to confirm whether such a strategy may be effective in the treatment of implant-associated infections caused by streptococci.
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Affiliation(s)
- Mercedes Gonzalez Moreno
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery; Berlin, Germany.,Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin; Berlin, Germany
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery; Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin; Berlin, Germany
| | - Mariagrazia Di Luca
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery; Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin; Berlin, Germany.,NEST, Istituto Nanoscienze - Consiglio Nazionale delle Ricerche; Pisa, Italy
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Huttner A, Kowalczyk A, Turjeman A, Babich T, Brossier C, Eliakim-Raz N, Kosiek K, Martinez de Tejada B, Roux X, Shiber S, Theuretzbacher U, von Dach E, Yahav D, Leibovici L, Godycki-Ćwirko M, Mouton JW, Harbarth S. Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women: A Randomized Clinical Trial. JAMA 2018; 319:1781-1789. [PMID: 29710295 PMCID: PMC6134435 DOI: 10.1001/jama.2018.3627] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
IMPORTANCE The use of nitrofurantoin and fosfomycin has increased since guidelines began recommending them as first-line therapy for lower urinary tract infection (UTI). OBJECTIVE To compare the clinical and microbiologic efficacy of nitrofurantoin and fosfomycin in women with uncomplicated cystitis. DESIGN, SETTING, AND PARTICIPANTS Multinational, open-label, analyst-blinded, randomized clinical trial including 513 nonpregnant women aged 18 years and older with symptoms of lower UTI (dysuria, urgency, frequency, or suprapubic tenderness), a positive urine dipstick result (with detection of nitrites or leukocyte esterase), and no known colonization or previous infection with uropathogens resistant to the study antibiotics. Recruitment took place from October 2013 through April 2017 at hospital units and outpatient clinics in Geneva, Switzerland; Lodz, Poland; and Petah-Tiqva, Israel. INTERVENTIONS Participants were randomized in a 1:1 ratio to oral nitrofurantoin, 100 mg 3 times a day for 5 days (n = 255), or a single 3-g dose of oral fosfomycin (n = 258). They returned 14 and 28 days after therapy completion for clinical evaluation and urine culture collection. MAIN OUTCOMES AND MEASURES The primary outcome was clinical response in the 28 days following therapy completion, defined as clinical resolution (complete resolution of symptoms and signs of UTI without prior failure), failure (need for additional or change in antibiotic treatment due to UTI or discontinuation due to lack of efficacy), or indeterminate (persistence of symptoms without objective evidence of infection). Secondary outcomes included bacteriologic response and incidence of adverse events. RESULTS Among 513 patients who were randomized (median age, 44 years [interquartile range, 31-64]), 475 (93%) completed the trial and 377 (73%) had a confirmed positive baseline culture. Clinical resolution through day 28 was achieved in 171 of 244 patients (70%) receiving nitrofurantoin vs 139 of 241 patients (58%) receiving fosfomycin (difference, 12% [95% CI, 4%-21%]; P = .004). Microbiologic resolution occurred in 129 of 175 (74%) vs 103 of 163 (63%), respectively (difference, 11% [95% CI, 1%-20%]; P = .04). Adverse events were few and primarily gastrointestinal; the most common were nausea and diarrhea (7/248 [3%] and 3/248 [1%] in the nitrofurantoin group vs 5/247 [2%] and 5/247 [1%] in the fosfomycin group, respectively). CONCLUSIONS AND RELEVANCE Among women with uncomplicated UTI, 5-day nitrofurantoin, compared with single-dose fosfomycin, resulted in a significantly greater likelihood of clinical and microbiologic resolution at 28 days after therapy completion. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01966653.
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Affiliation(s)
- Angela Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Anna Kowalczyk
- Centre for Family and Community Medicine, Medical University of Lodz, Lodz, Poland
| | - Adi Turjeman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tanya Babich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Caroline Brossier
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Noa Eliakim-Raz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Peta-Tiqva, Israel
| | - Katarzyna Kosiek
- Faculty of Health Sciences, Division of Public Health, Medical University of Lodz, Lodz, Poland
| | - Begoña Martinez de Tejada
- Obstetrics Division, Department of Obstetrics and Gynecology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Xavier Roux
- Department of Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Shachaf Shiber
- Department of Emergency Medicine, Rabin Medical Center, Beilinson Campus, Peta-Tiqva, Israel
| | | | - Elodie von Dach
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Clinical Trials Unit, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel
| | - Leonard Leibovici
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Peta-Tiqva, Israel
| | - Maciek Godycki-Ćwirko
- Centre for Family and Community Medicine, Medical University of Lodz, Lodz, Poland
- Faculty of Health Sciences, Division of Public Health, Medical University of Lodz, Lodz, Poland
| | - Johan W. Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Costa T, Linhares I, Ferreira R, Neves J, Almeida A. Frequency and Antibiotic Resistance of Bacteria Implicated in Community Urinary Tract Infections in North Aveiro Between 2011 and 2014. Microb Drug Resist 2018; 24:493-504. [DOI: 10.1089/mdr.2016.0318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Tânia Costa
- Department of Biology and CESAM, University of Aveiro, Aveiro, Portugal
- Centro Médico da Praça Lda, São João da Madeira, Portugal
| | - Inês Linhares
- Department of Biology and CESAM, University of Aveiro, Aveiro, Portugal
| | | | - Jasmin Neves
- Centro Médico da Praça Lda, São João da Madeira, Portugal
| | - Adelaide Almeida
- Department of Biology and CESAM, University of Aveiro, Aveiro, Portugal
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Gandhi A, Matta M, Garimella N, Zere T, Weaver J. Development and validation of a LC-MS/MS method for quantitation of fosfomycin - Application to in vitro antimicrobial resistance study using hollow-fiber infection model. Biomed Chromatogr 2018; 32:e4214. [PMID: 29461629 DOI: 10.1002/bmc.4214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/31/2018] [Accepted: 02/09/2018] [Indexed: 11/05/2022]
Abstract
Extensive use and misuse of antibiotics over the past 50 years has contributed to the emergence and spread of antibiotic-resistant bacterial strains, rendering them as a global health concern. To address this issue, a dynamic in vitro hollow-fiber system, which mimics the in vivo environment more closely than the static model, was used to study the emergence of bacterial resistance of Escherichia coli against fosfomycin (FOS). To aid in this endeavor we developed and validated a liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay for quantitative analysis of FOS in lysogeny broth. FOS was resolved on a Kinetex HILIC (2.1 × 50 mm, 2.6 μm) column with 2 mm ammonium acetate (pH 4.76) and acetonitrile as mobile phase within 3 min. Multiple reaction monitoring was used to acquire data on a triple quadrupole mass spectrometer. The assay was linear from 1 to 1000 μg/mL. Inter- and intra-assay precision and accuracy were <15% and between ±85 and 115% respectively. No significant matrix effect was observed when corrected with the internal standard. FOS was stable for up to 24 h at room temperature, up to three freeze-thaw cycles and up to 24 h when stored at 4°C in the autosampler. In vitro experimental data were similar to the simulated plasma pharmacokinetic data, further confirming the appropriateness of the experimental design to quantitate antibiotics and study occurrence of antimicrobial resistance in real time. The validated LC-MS/MS assays for quantitative determination of FOS in lysogeny broth will help antimicrobial drug resistance studies.
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Affiliation(s)
- Adarsh Gandhi
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Murali Matta
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Narayana Garimella
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Tesfalem Zere
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Food and Drug Administration, Silver Spring, Maryland, USA
| | - James Weaver
- Division of Applied Regulatory Science, Office of Clinical Pharmacology, Food and Drug Administration, Silver Spring, Maryland, USA
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Mubarak Z, Soraya C. The acid tolerance response and pH adaptation of Enterococcus faecalis in extract of lime Citrus aurantiifolia from Aceh Indonesia. F1000Res 2018; 7:287. [PMID: 29721312 PMCID: PMC5897787 DOI: 10.12688/f1000research.13990.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 11/23/2022] Open
Abstract
Background: The objective of the present study was to evaluate the acid tolerance response and pH adaptation when
Enterococcusfaecalis interacted with extract of lime (
Citrus aurantiifolia). Methods: We used
E. faecalis ATCC 29212 and lime extract from Aceh, Indonesia. The microbe was analyzed for its pH adaptation, acid tolerance response, and adhesion assay using a light microscope with a magnification of x1000. Further, statistical tests were performed to analyze both correlation and significance of the acid tolerance and pH adaptation as well as the interaction activity. Results:E. faecalis was able to adapt to a very acidic environment (pH 2.9), which was characterized by an increase in its pH (reaching 4.2) at all concentrations of the lime extract (p < 0.05).
E. faecalis was also able to provide acid tolerance response to lime extract based on spectrophotometric data (595 nm) (p < 0.05). Also, the interaction activity of
E. faecalis in different concentrations of lime extract was relatively stable within 6 up to 12 hours (p < 0.05), but it became unstable within 24–72 hours (p > 0.05) based on the mass profiles of its interaction activity. Conclusions:E. faecalis can adapt to acidic environments (pH 2.9–4.2); it is also able to tolerate acid generated by
Citrus aurantiifolia extract, revealing a stable interaction in the first 6–12 hours.
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Affiliation(s)
- Zaki Mubarak
- Faculty of Dentistry, University of Syiah Kuala, Banda Aceh, Indonesia
| | - Cut Soraya
- Faculty of Dentistry, University of Syiah Kuala, Banda Aceh, Indonesia
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32
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Ou LB, Nadeau L. Fosfomycin Susceptibility in Multidrug-Resistant Enterobacteriaceae Species and Vancomycin-Resistant Enterococci Urinary Isolates. Can J Hosp Pharm 2017; 70:368-374. [PMID: 29109580 DOI: 10.4212/cjhp.v70i5.1698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background 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 β-lactamase [ESBL] or AmpC β-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 β-lactamase-producing Enterobacteriaceae (95 Escherichia coli, 11 Klebsiella spp.) and 31 positive for vancomycin-resistant Enterococcus faecium. Susceptibility rates for ESBL- and AmpC β-lactamase-producing E. coli were 100% for ertapenem, 96% for fosfomycin, 83% for nitrofurantoin, 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.
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Affiliation(s)
- Linda B Ou
- , BSc(Pharm), ACPR, was, at the time of this study, a Pharmacy Resident at Windsor Regional Hospital, Windsor, Ontario. She is now a candidate in the Master of Science Epidemiology program at McGill University, Montréal, Quebec
| | - Lynn Nadeau
- , PharmD, is a Clinical Pharmacy Specialist in Infectious Diseases at Windsor Regional Hospital, Windsor, Ontario
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Bacteriology in uncomplicated urinary tract infections in Norwegian general practice from 2001-2015. BJGP Open 2017; 1:bjgpopen17X101145. [PMID: 30564685 PMCID: PMC6181106 DOI: 10.3399/bjgpopen17x101145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Uncomplicated urinary tract infections in women are common, and urine samples from these patients are not routinely cultured. Empirical treatment is based on knowledge of resistance patterns for common uropathogens. Aim To evaluate the bacteriological findings and resistance patterns in urine samples from women with uncomplicated urinary tract infections, and to assess the relationship between antimicrobial use and resistance patterns from 2000–2015 in Norway. Method Bacteriology and resistance patterns were compared in 184 urine cultures from 2001, 406 urine cultures from 2010–2011 and 259 urine cultures from 2013–2015. Antibiotic use data from 2000–2015 were obtained from national databases. Results Escherichia coli (E. coli) was the main bacterial agent in 80% of the cultures. Staphylococcus saprophyticus (Staph. saprophyticus) represented 6–17%. For E. coli, resistance to mecillinam showed some variation but remained below 9%. There was negligible resistance to nitrofurantoin. Resistance to trimethoprim seemed to stabilise over the last 5 years at around 20%. Amoxicillin resistance had some variations, but remained stable around 30%. There was a steady rise in total consumption of selected antibiotics commonly used to treat urinary tract infections for the period 2000–2015. Conclusion Mecillinam and nitrofurantoin are both excellent first choices for empirical treatment of uncomplicated urinary tract infections. This study suggests that increasing resistance to trimethoprim challenges the rationale for its use as a first-line agent.
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Patwardhan V, Singh S. Fosfomycin for the treatment of drug-resistant urinary tract infections: potential of an old drug not explored fully. Int Urol Nephrol 2017; 49:1637-1643. [PMID: 28616818 DOI: 10.1007/s11255-017-1627-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/19/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Increased emergence of bacterial resistance and the limited options of novel antimicrobial agents have necessitated the reintroduction of some old antimicrobial agents. One such drug is fosfomycin, but its potential has not been explored fully, especially in India. AIMS AND OBJECTIVES To analyze the in vitro activity of fosfomycin, against the urinary isolates and to compare it with in vitro activity of other orally administered antimicrobial agents. MATERIALS AND METHODS This was a prospective observational study conducted between July 2014 and June 2016. All consecutive, non-duplicate and clinically significant urinary isolates obtained from patients of all ages and both genders, diagnosed to have UTI, were included. Patients already on antibiotic therapy were excluded. Urine culture was performed by semiquantitative method on cysteine lactose electrolyte-deficient medium and the isolates obtained in significant count were subjected to antimicrobial sensitivity testing by the Kirby Bauer disk diffusion method as per CLSI guidelines. RESULTS A total of 3947 non-repeating urinary isolates were included in the study, of which 2684 (68%) isolates originated from adult outpatients and remaining 1236 (32%) isolates from pediatric patients. Of these 2783 isolates were from enterobacteriaceae family. Out of these 2730 (98.1%) were sensitive to fosfomycin. Most [375 of 385 (97.4%)] Pseudomonas spp were also susceptible to fosfomycin. A majority of ESBL- (96.5%) and MBL (91.9%)-producing isolates were also susceptible to fosfomycin and so were of Gram-positive isolates [698/707 (96%)] and MRSA [61/69 (88.4%)] were susceptible to fosfomycin. CONCLUSIONS Fosfomycin showed an excellent in vitro activity against all urinary pathogens, including the Gram-positive or Gram-negative, ESBL and MBL producers. Fosfomycin should be considered as a highly effective alternative in treatment UTIs in both adults and pediatric patients.
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Intravenous fosfomycin—back to the future. Systematic review and meta-analysis of the clinical literature. Clin Microbiol Infect 2017; 23:363-372. [DOI: 10.1016/j.cmi.2016.12.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/12/2016] [Accepted: 12/03/2016] [Indexed: 11/20/2022]
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Etiological and Resistance Profile of Bacteria Involved in Urinary Tract Infections in Young Children. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4909452. [PMID: 28497052 PMCID: PMC5405357 DOI: 10.1155/2017/4909452] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/30/2017] [Indexed: 12/02/2022]
Abstract
Background. The objective of this study was to identify the bacteria most frequently responsible for urinary tract infection (UTI) in the population of under-2-year-olds in our geographic area and to evaluate the activity of antibiotics widely used for UTI treatment during a 4-year study period. Materials and Methods. A retrospective analysis was conducted of data on the identification and susceptibility of microorganisms isolated in urine samples from children under 2 years of age. Results. A total of 1,045 uropathogens were isolated. Escherichia coli accounted for the majority (60.3%) of these, followed by Enterococcus faecalis (22.4%) and Klebsiella spp. (6.5%). The highest E. coli susceptibility rates (>90%) were to piperacillin-tazobactam, cefuroxime, cefotaxime, ceftazidime, imipenem, gentamicin, nitrofurantoin, and fosfomycin, and the lowest were to amoxicillin-clavulanic acid and cotrimoxazole. Among all bacteria isolated, we highlight the overall high activity of piperacillin-tazobactam, imipenem, nitrofurantoin, and fosfomycin against both community and hospital isolates and the reduced activity of amoxicillin-clavulanic acid, cephalosporins, gentamicin, and cotrimoxazole. There was no significant change in the total activity of any of the studied antibiotics over the 4-year study period. Conclusion. Empiric treatment with amoxicillin-clavulanic acid, cotrimoxazole, cephalosporins, and gentamicin may be inadequate due to their limited activity against uropathogens in our setting.
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Mezzatesta ML, La Rosa G, Maugeri G, Zingali T, Caio C, Novelli A, Stefani S. In vitro activity of fosfomycin trometamol and other oral antibiotics against multidrug-resistant uropathogens. Int J Antimicrob Agents 2017; 49:763-766. [PMID: 28390962 DOI: 10.1016/j.ijantimicag.2017.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/10/2017] [Accepted: 01/14/2017] [Indexed: 11/25/2022]
Abstract
Clinical midstream and urinary catheter isolates (n = 106) of extended-spectrum β-lactamase (ESBL)-positive Escherichia coli, Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae, Proteus mirabilis and meticillin-resistant Staphylococcus saprophyticus were tested against fosfomycin using the agar dilution method, the broth microdilution method and the gradient test described by the Clinical and Laboratory Standards Institute. Nitrofurantoin, co-trimoxazole, amoxicillin/clavulanic acid, cefuroxime, levofloxacin and ciprofloxacin were tested using the gradient test alone. Breakpoints from the European Committee on Antimicrobial Susceptibility Testing 2015 guidelines were used. Fosfomycin inhibited all of the ESBL-positive E. coli, P. mirabilis and meticillin-resistant S. saprophyticus strains isolated from urine, as well as 82% of KPC-producing K. pneumoniae isolates. Substantial agreement for fosfomycin activity was found for the three test methods, particularly for Enterobacteriaceae. This study confirmed that fosfomycin has good in vitro activity against more common multidrug-resistant uropathogens. Fosfomycin could be a reliable empirical therapeutic option for uncomplicated urinary tract infections caused by these organisms, and a valid option for sparing parenteral antibiotics, such as carbapenems.
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Affiliation(s)
- Maria Lina Mezzatesta
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy.
| | - Giulia La Rosa
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy
| | - Gaetano Maugeri
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy
| | - Tiziana Zingali
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy
| | - Carla Caio
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Catania, Italy
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Chacón-Mora N, Pachón Díaz J, Cordero Matía E. Urinary tract infection in kidney transplant recipients. Enferm Infecc Microbiol Clin 2017; 35:255-259. [DOI: 10.1016/j.eimc.2016.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/12/2016] [Accepted: 03/14/2016] [Indexed: 12/26/2022]
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Giancola SE, Mahoney MV, Hogan MD, Raux BR, McCoy C, Hirsch EB. Assessment of Fosfomycin for Complicated or Multidrug-Resistant Urinary Tract Infections: Patient Characteristics and Outcomes. Chemotherapy 2016; 62:100-104. [PMID: 27788499 DOI: 10.1159/000449422] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/25/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bacterial resistance among uropathogens is on the rise and has led to a decreased effectiveness of oral therapies. Fosfomycin tromethamine (fosfomycin) is indicated for uncomplicated urinary tract infections (UTIs) and displays in vitro activity against multidrug-resistant (MDR) isolates; however, clinical data assessing fosfomycin for the treatment of complicated or MDR UTIs are limited. METHODS We conducted a retrospective evaluation of patients who received ≥1 dose of fosfomycin between January 2009 and September 2015 for treatment of a UTI. Patients were included if they had a positive urine culture and documented signs/symptoms of a UTI. RESULTS Fifty-seven patients were included; 44 (77.2%) had complicated UTIs, 36 (63.2%) had MDR UTIs, and a total of 23 (40.4%) patients had a UTI that was both complicated and MDR. The majority of patients were female (66.7%) and elderly (median age, 79 years). Overall, the most common pathogens isolated were Escherichia coli (n = 28), Enterococcus spp. (n = 22), and Pseudomonas aeruginosa (n = 8). Twenty-eight patients (49.1%) were clinically evaluable; the preponderance achieved clinical success (96.4%). Fifteen out of 20 (75%) patients with repeat urine cultures had a microbiological cure. CONCLUSIONS This retrospective study adds to the limited literature exploring alternative therapies for complicated and MDR UTIs with results providing additional evidence that fosfomycin may be an effective oral option.
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Affiliation(s)
- Stephanie E Giancola
- Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, Mass., USA
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Abstract
The treatment of bacterial infections suffers from two major problems: spread of multidrug-resistant (MDR) or extensively drug-resistant (XDR) pathogens and lack of development of new antibiotics active against such MDR and XDR bacteria. As a result, physicians have turned to older antibiotics, such as polymyxins, tetracyclines, and aminoglycosides. Lately, due to development of resistance to these agents, fosfomycin has gained attention, as it has remained active against both Gram-positive and Gram-negative MDR and XDR bacteria. New data of higher quality have become available, and several issues were clarified further. In this review, we summarize the available fosfomycin data regarding pharmacokinetic and pharmacodynamic properties, the in vitro activity against susceptible and antibiotic-resistant bacteria, mechanisms of resistance and development of resistance during treatment, synergy and antagonism with other antibiotics, clinical effectiveness, and adverse events. Issues that need to be studied further are also discussed.
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Heytens S, Boelens J, Claeys G, DeSutter A, Christiaens T. Uropathogen distribution and antimicrobial susceptibility in uncomplicated cystitis in Belgium, a high antibiotics prescribing country: 20-year surveillance. Eur J Clin Microbiol Infect Dis 2016; 36:105-113. [PMID: 27639858 DOI: 10.1007/s10096-016-2776-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/01/2016] [Indexed: 11/27/2022]
Abstract
Treatment of cystitis in primary care is usually empirical, guided by the prior probability of causal pathogens and their susceptibility. To re-evaluate empirical treatment guidelines, the actual distribution and susceptibility of uropathogens was examined and compared with two previous surveys in Belgium over the past 20 years. Because of the alarming increase in carriage of extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Escherichia coli, this specific resistance was explored. From May 2014 to December 2015, 120 general practitioners collected midstream urine specimens from adult pre- and postmenopausal female patients with suspected cystitis. A dipslide was inoculated and sent for microbiological analysis. Anal swabs were collected for ESBL and carbapenemase detection. Of 265 enrolled patients, 203 (79.3 %) had a positive culture. Escherichia coli (81.6 %) was the most frequently isolated uropathogen, followed by Staphylococcus saprophyticus (8 %), confirming the results of the 1995 and 2005 surveys. The susceptibility of E. coli remained nearly 100 % for nitrofurantoin and fosfomycin, decreased from nearly 100 % in 1995 to 94.2 % for quinolones, from 73.2 to 55.5 % for ampicillin, and from 83.3 to 76.3 % for trimethoprim-sulfamethoxazole (TMP-SMX). In E. coli present in positive urine cultures, ESBLs were found in 2.5 % and carbapenemases were absent. In fecal specimens, ESBL-producing E. coli were found in 7.9 % and carbapenemases were not detected. Over a 20-year period, the distribution of uropathogens in women with cystitis remained unchanged. Susceptibility remained excellent for nitrofurantoin and fosfomycin. For TMP-SMX, ampicillin, and quinolones, there was a decrease.
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Affiliation(s)
- S Heytens
- Department of Family Medicine and Primary Health Care, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| | - J Boelens
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium
| | - G Claeys
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium
| | - A DeSutter
- Department of Family Medicine and Primary Health Care, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium
| | - T Christiaens
- Department of Clinical Pharmacology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium
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Seroy JT, Grim SA, Reid GE, Wellington T, Clark NM. Treatment of MDR urinary tract infections with oral fosfomycin: a retrospective analysis. J Antimicrob Chemother 2016; 71:2563-8. [DOI: 10.1093/jac/dkw178] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/18/2016] [Indexed: 11/14/2022] Open
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Yeganeh-Sefidan F, Ghotaslou R, Akhi MT, Sadeghi MR, Mohammadzadeh-Asl Y, Bannazadeh Baghi H. Fosfomycin, interesting alternative drug for treatment of urinary tract infections created by multiple drug resistant and extended spectrum β-lactamase producing strains. IRANIAN JOURNAL OF MICROBIOLOGY 2016; 8:125-31. [PMID: 27307978 PMCID: PMC4906719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVES The emergence and spread of multidrug resistant (MDR) and extended spectrum β-lactamase (ESBL) producing strains reduces the number of effective drugs that can be used for treatment. The aim of this study was to evaluate the susceptibility profile of Enterobacteriaceae isolated from UTIs, specifically MDR and ESBL producing strains, to fosfomycin and other antibiotics. MATERIALS AND METHODS The study was performed during a 6 month period (February 2014 to August 2015). A total of 219 non-duplicate urinary isolates of Enterobacteriaceae were collected. Identification and susceptibility testing was done according to standard microbiological procedures and the Kirby-Bauer test, respectively. Based on the results obtained from susceptibility testing, MDR bacteria were recovered and identification of ESBL production was done according to CLSI recommendation. RESULTS Isolates of E. coli and Klebsiella spp. were responsible for 80.8% and 12.8% of patients with UTIs respectively. The rates of resistance to ampicillin, cefazolin, nalidixic acid, trimethoprim-sulfamethoxazole were 86.3%, 79.4%, 68.5% and 63.9% respectively. In contrast, high sensitivity rates were detected to fosfomycin, amikacin and amoxicillin-clavulanic acid with 97.3%, 91.8% and 80.8%, respectively. Of all isolates, 167 (76.3%) were detected as MDR and 75 (34.2%) as ESBL producing strains. CONCLUSION The rate of antibiotic resistance among uropathogens Enterobacteriaceae is remarkably high. The most effective antibiotic was fosfomycin. Moreover, susceptibility to fosfomycin is over 90% for MDR and ESBL producer isolates. Therefore, fosfomycin can be a good option for treating UTIs.
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Affiliation(s)
- Fatemeh Yeganeh-Sefidan
- Tropical and Infectious Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran,Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Ghotaslou
- Tropical and Infectious Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran,Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding author: Reza Ghotaslou, PhD. Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Telefax: +984133364661,
| | - Mohammad Taghi Akhi
- Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Reza Sadeghi
- Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yalda Mohammadzadeh-Asl
- Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hussein Bannazadeh Baghi
- Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Mehta M, Sharma J, Bhardwaj S. Susceptibility of Urinary Tract Bacteria to Newer Antimicrobial Drugs. Open Access Maced J Med Sci 2016; 4:22-4. [PMID: 27275323 PMCID: PMC4884245 DOI: 10.3889/oamjms.2016.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/17/2014] [Accepted: 01/02/2015] [Indexed: 11/25/2022] Open
Abstract
Urinary tract infections (UTIs) are among the commonest types of bacterial infections. The antibiotic treatment for UTIs is associated with important medical and economic implications. Many different microorganisms can cause UTIs though the most common pathogens are E. coli and members of family Enterobacteriaceae. The knowledge of etiology and antibiotic resistance pattern of the organisms causing urinary tract infection is essential. The present study was undertaken to evaluate trends of antibiotic susceptibility of commonly isolated uropathogens using newer antimicrobial agents, prulifloxacin, fosfomycin (FOM) and doripenem. We conclude that maintaining a record of culture results and the antibiogram may help clinicians to determine the empirical and/or specific treatment based on the antibiogram of the isolate for better therapeutic outcome.
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Affiliation(s)
- Manjula Mehta
- Dr. Harvansh Singh Judge Institute of Dental Science & Hospital, Panjab University, Chandigarh, India
| | - Jyoti Sharma
- Dr. Harvansh Singh Judge Institute of Dental Science & Hospital, Panjab University, Chandigarh, India
| | - Sonia Bhardwaj
- Dr. Harvansh Singh Judge Institute of Dental Science & Hospital, Panjab University, Chandigarh, India
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Fosfomycin: Resurgence of an old companion. J Infect Chemother 2016; 22:273-80. [PMID: 26923259 DOI: 10.1016/j.jiac.2016.01.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/18/2016] [Indexed: 11/20/2022]
Abstract
Fosfomycin was discovered over four decades ago, yet has drawn renewed interest as an agent active against a range of multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens. Its unique mechanism of action and broad spectrum of activity makes it a promising candidate in the treatment of various MDR/XDR infections. There has been a surge of in vitro data on its activity against MDR/XDR organisms, both when used as a single agent and in combination with other agents. In the United States, fosfomycin is only approved in an oral formulation for the treatment of acute uncomplicated urinary tract infections (UTIs), whereas in some countries both oral and intravenous formulations are available for various indications. Fosfomycin has minimal interactions with other medications and has a relatively favorable safety profile, with diarrhea being the most common adverse reaction. Fosfomycin has low protein binding and is excreted primarily unchanged in the urine. The clinical outcomes of patients treated with fosfomycin are favorable for uncomplicated UTIs, but data are limited for use in other conditions. Fosfomycin maintains activity against most Enterobacteriaceae including Escherichia coli, but plasmid-mediated resistance due to inactivation have appeared in recent years, which has the potential to compromise its use in the future. In this review, we summarize the current knowledge of this resurgent agent and its role in our antimicrobial armamentarium.
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Sabharwal ER, Sharma R. Fosfomycin: An Alternative Therapy for the Treatment of UTI Amidst Escalating Antimicrobial Resistance. J Clin Diagn Res 2015; 9:DC06-9. [PMID: 26816887 DOI: 10.7860/jcdr/2015/15227.6951] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/19/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Urinary tract infections (UTIs) are the most commonly encountered infectious diseases. The current study was undertaken with a dual purpose, to provide an insight into the current scenario of the microorganisms causing UTI, their antimicrobial sensitivity patterns and also try and evaluate the activity of fosfomycin against E. coli, both ESBL producers as well as non-producers. MATERIALS AND METHODS The study was conducted prospectively in the Department of Microbiology of a tertiary care hospital from January to June 2014. A total of 358 isolates from the urinary samples of the patients with a diagnosis of urinary tract infection were included in the study. Antibiotic sensitivity testing and extended spectrum beta lactamase (ESBL) production testing was done as per CLSI guidelines. RESULTS These represented 297 (82.9%) gram-negative isolates and 61 (17%) gram-positive isolates. The 297 gram-negative isolates represented 265 (89.2%) members of the Enterobacteriaceae, 185 (69.8%) of which were Escherichia coli, 66 (24.9%) Klebsiella spp. and 14 (5.28%) Proteus spp. Non-fermentative Pseudomonas spp were isolated from 8.9% cases. Amongst the Gram negative isolates tested, 78 (21.8%) formed extended spectrum beta-lactamases. Of the total 358 isolates tested, 338 (94.4%) were found to be susceptible to fosfomycin. CONCLUSION Fosfomycin showed good activity against both ESBL-producing and ESBL-negative E. coli isolates. The main finding of our study is that fosfomycin exhibits excellent antimicrobial activity even against the isolates with relatively high levels of antimicrobial resistance and hence can be a useful drug in our armamentarium.
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Affiliation(s)
- Ekadashi Rajni Sabharwal
- Assistant Professor, Department of Microbiology, Ruhs College of Medical Sciences , Jaipur, India
| | - Rajni Sharma
- Senior Resident, Department of Microbiology, Ram Manohar Lohia Hospital , New Delhi, India
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Activity of fosfomycin and comparison of several susceptibility testing methods against contemporary urine isolates. Int J Antimicrob Agents 2015; 46:642-7. [DOI: 10.1016/j.ijantimicag.2015.08.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/10/2015] [Accepted: 08/12/2015] [Indexed: 11/21/2022]
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Khawaja AR, Khan FB, Dar TI, Bhat AH, Wani MS, Wazir BS. Fosfomycin tromethamine. Antibiotic of choice in the female patient: A multicenter study. Cent European J Urol 2015; 68:371-5. [PMID: 26568884 PMCID: PMC4643705 DOI: 10.5173/ceju.2015.590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction The aim of this study was to evaluate oral single/multiple doses of Fosfomycin Trometamol with clinical and microbiological efficacy in:Asymptomatic bacteriuria in pregnancy. Endourological procedures. Lower urinary tract infections.
Material and methods This prospective, uncontrolled, open label study was conducted in two tertiary hospitals over a period of three years. A total of 400 patients were included in the study. Group A (200 patients) with asymptomatic bacteriuria in pregnancy and Group B (200 Patients) with symptomatic lower urinary tract infections and with any day care endourological procedures were enrolled in our study. Efficacy end points like post- antibiotic urinalysis, microbiological efficacy and clinical improvement with adverse effects of the drug were evaluated. Results Of the 400 patients studied, 98% returned for follow-up. Out of the 304 urinary isolates in Table 2 (ASB and symptomatic LUTS) grown on urinary culture, majority of the isolates were Gram-negative Enterobacteriacae family. After oral single/multiple doses of fosfomycin, bacterial eradication, bacterial persistence, bacterial reinfection were 96.3%, 3.9%, 3.9% respectively (Figure 2). No isolates were grown in 8 cases (Table 2). However, on administration of the drug 23.5% patients noticed diarrhea (loose stools) followed by itching (19.7%) in genital area (Figure 1). Conclusions Fosfomycin Trometamol is a bactericidal antibiotic with a broad spectrum activity against Gram-positive also Gram-negative bacteriae. It has an advantage of oral single /multiple doses, higher eradication rate of bacteria after 48 hours, excellent tolerability and safety in pregnancy and other female age groups. We recommend Fosfomycin Trometamol as the drug of choice particularly in patients with poor drug compliance and for minor day care endourological procedures.
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Affiliation(s)
- Abdul Rouf Khawaja
- Sheri Kashmir Institute of Medical Sciences Soura Srinagar; Government Medical College Srinagar Jammu and Kashmir, India
| | - Farzana Bashir Khan
- Sheri Kashmir Institute of Medical Sciences Soura Srinagar; Government Medical College Srinagar Jammu and Kashmir, India
| | - Tanveer Iqbal Dar
- Sheri Kashmir Institute of Medical Sciences Soura Srinagar; Government Medical College Srinagar Jammu and Kashmir, India
| | - Arif Hameed Bhat
- Sheri Kashmir Institute of Medical Sciences Soura Srinagar; Government Medical College Srinagar Jammu and Kashmir, India
| | - Mohd Saleem Wani
- Sheri Kashmir Institute of Medical Sciences Soura Srinagar; Government Medical College Srinagar Jammu and Kashmir, India
| | - Baldev Singh Wazir
- Sheri Kashmir Institute of Medical Sciences Soura Srinagar; Government Medical College Srinagar Jammu and Kashmir, India
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Walsh CC, McIntosh MP, Peleg AY, Kirkpatrick CM, Bergen PJ. In vitro pharmacodynamics of fosfomycin against clinical isolates of Pseudomonas aeruginosa. J Antimicrob Chemother 2015. [PMID: 26209311 DOI: 10.1093/jac/dkv221] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The use of fosfomycin for treatment of systemic infections due to MDR Pseudomonas aeruginosa is increasing. However, pharmacodynamic data for fosfomycin are limited. METHODS Sixty-four clinical isolates of P. aeruginosa (MDR and non-MDR) from two Australian hospitals were collected; 59 isolates were from patients with cystic fibrosis and 5 isolates were from critically ill patients. The in vitro pharmacodynamic properties of fosfomycin (disodium) were investigated via MICs (all isolates) and, for selected isolates, via time-kill kinetics (static and dynamic models; concentration range, 1-1024 mg/L), population analysis profiles (PAPs) and post-antibiotic effect (PAE). Two inocula (∼10(6) and ∼10(8) cfu/mL) were included in static time-kill studies to examine the effect of inocula on bacterial killing. RESULTS MICs ranged from 1 to >512 mg/L, with 61% of isolates considered fosfomycin susceptible (MIC ≤64 mg/L). The MIC distributions for MDR and non-MDR isolates were similar. Baseline PAPs indicated heteroresistance in all isolates tested. Time-kill studies showed moderate (maximum killing ∼3 log10 cfu/mL), time-dependent killing at the low inoculum with regrowth at 24 h. Most concentrations resulted in complete replacement of fosfomycin-susceptible colonies by fosfomycin-resistant colonies. Bacterial killing was virtually eliminated at the high inoculum. The PAE ranged from 0.3 to 5.5 h. CONCLUSIONS These data suggest monotherapy with fosfomycin may be problematic for the treatment of infections caused by P. aeruginosa. Further investigation of fosfomycin combination therapy is warranted.
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Affiliation(s)
- Clare C Walsh
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Michelle P McIntosh
- Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Anton Y Peleg
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia Department of Microbiology, School of Biomedical Sciences, Monash University, Clayton, Victoria, Australia
| | - Carl M Kirkpatrick
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Phillip J Bergen
- Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
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Falagas ME, Rafailidis PI. Editorial Commentary: Fosfomycin: The Current Status of the Drug. Clin Infect Dis 2015; 61:1144-6. [PMID: 26063717 DOI: 10.1093/cid/civ443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/02/2023] Open
Affiliation(s)
- Matthew E Falagas
- Alfa Institute of Biomedical Sciences Department of Internal Medicine-Infectious Diseases, Iaso General Hospital, Iaso Group, Athens, Greece Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Petros I Rafailidis
- Alfa Institute of Biomedical Sciences Department of Internal Medicine, Athens Medical Center, Athens Medical Group, Greece
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