Prevalence of Fosfomycin Resistance Among Enterobacterales Isolates in A Tertiary Care Hospital from Turkey

Abstract

Objective: Urinary tract infections are one of the most common causes of morbidity around the world. Fosfomycin is a specific broad-spectrum antibiotic used to treat these infections. However, in recent years, many studies have reported increased fosfomycin resistance in Enterobacterales isolates. Therefore, this study aimed to evaluate the distribution of pathogens isolated from urine samples and find the fosfomycin resistance rates over nine years (2012-2020).

Materials and methods: A total of 18,884 uropathogenic Enterobacterales isolates were included in the study between 2012 and 2020. The isolates were identified by VITEK^® 2 Compact (bioMérieux, Marcy l'Etoile, France), and the antimicrobial susceptibilities of the isolates were also evaluated using the VITEK^® MS automated system (bioMérieux, Marcy l'Etoile, France).

Results: Escherichia coli (64.04%) was the most common bacteria among Enterobacterales. Fosfomycin resistance rates were 1.98%, 21.64%, and 10.36% in E. coli, Klebsiella pneumoniae, and all bacteria, respectively. The 34.97% of isolates were extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, and the fosfomycin resistance rate was 13.08% in these isolates. In addition, fosfomycin resistance rates were found as 3.06% and 23.84% in ESBL-producing E. coli and ESBL-producing K. pneumoniae, respectively.

Conclusion: Fosfomycin seems a good option for effectively treating UTIs caused by E. coli. On the other hand, we found that fosfomycin resistance tends to increase over the years. Therefore, we recommend further studies to evaluate fosfomycin resistance.

Keywords: Enterobacterales; extended-spectrum beta-lactamases producing; fosfomycin resistance.