BACKGROUND: The incidence of urinary tract infections (UTIs) caused by extended-spectrum-beta-lactamase (ESBL) producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) has been on the rise limiting oral treatment options.
Fosfomycin was reported to be highly efficacious against these organisms, however, data is lacking in Lebanon and the Middle East.
OBJECTIVE: To determine the in vitro activity of fosfomycin against ESBL and non-ESBL-producing E. coli and K. pneumoniae uropathogens in Lebanon.
METHODS: A total of 542 consecutive non-duplicate isolates of ESBL-producing E. coli (n = 374) and K. pneumoniae (n = 168), and 291 isolates of non-ESBL-producing E. coli (n = 236) and K. pneumoniae (n = 55) were recovered from urine specimens of patients tested at the American University of Beirut Medical Center (AUBMC) during 2010. Each isolate was tested against a battery of 13 antimicrobials by disk diffusion according to the guidelines of CLSI testing and result interpretation criteria.
RESULTS: The fosfomycin susceptibility for ESBL-producing vs. non-ESBL-producing isolates was 86% vs. 97% for E. coli and 62% vs. 78% for K. pneumoniae. This activity of fosfomycin among ESBL-EC and ESBL-KP was generally higher than cefepime (26% & 30%), ciprofloxacin (24% & 41%), Trimeth/sulfa (26% & 19%), Pip/taz (75% and 45%), gentamicin (45% & 42%), and tobramycin (32% & 26%). On the other hand, higher activity against both species of ESBL-producing bacteria was shown by amikacin (96% & 79%) and imipenem (99.7% & 98.8%). Nitroflurantoin was highly active against ESBL-EC (95%) but not against ESBL-KP (29%).
CONCLUSION: Fosfomycin shows good activity, being higher against ESBL-producing E. coli than K. pneumoniae uropathogens in Lebanon.
Written by:
Araj GF, Jaber FA. Are you the author?
Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Reference: J Med Liban. 2012 Jul-Sep;60(3):142-7.
PubMed Abstract
PMID: 23198454
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