Abstract
INTRODUCTION AND OBJECTIVES: The appearance of extended-spectrum beta-lactamase (ESBL)-producing gram negative bacteria in urinary tract infections (UTIs) constitutes an important therapeutic challenge. The aim of this study was to describe drug susceptibility profiles of (ESBL)-producing gram-negative isolates recovered from urine samples. We also determined the antimicrobial coresistance to several agents, including fosfomycin METHODS: Retrospective analysis of 29,584 urine culture results obtained during January 2008 to December 2013 at Chonnam National Hwasun Hospital in Korea was done. The computerized database was used to identify ESBL-positive urine samples. A total of 869 ESBL positive strains were identified during the study period. We analyzed E. coli and Klebsiella isolates obtained from urine cultures and duplicate isolates; and no fosfomycin tests were excluded. The cases were further categorized according to UTI definition [community acquired (CA) UTI, health care-associated (HCA) UTI and hospital acquired (HA) UTI] and urology sample. ESBLisolates were stratified according their origin into two groups: Urology and non-Urology isolates RESULTS: Antimicrobial susceptibilities of the strains for fosfomycin were tested in 277 ESBL-positive strains: 217 ESBL-EC and 60 ESBL-KP. The most effective agents were carbapenem, such as imipenem and meropenem. The least active substances were ciprofloxacin (20.7%), Levofloxacin (22.7%), Trimethoprim-sulfamethoxazole (34.3%), and ampicillin-clavulanate (42.9 %). Overall, 243/277 (87.7%) of the isolates tested were susceptible to fosfomycin tromethamine. Higher fosfomycin sensitivity in E. coli (94.9%) were observed compared to Klebsiella (61.7%) (p1⁄40.001). ESBL-positive isolates from urological (68 isolates) and nonurological patients (209 isolates) showed similar susceptibility profiles. Except for carbapenem, CA-UTI showed higher sensitivity to fosfomycin (100%) and nitrofurantoin (93.1%), HCA-UTI showed higher sensitivity to amikacin (94.1%) and HA-UTI showed an overall poor sensitivity to antibiotics. CONCLUSIONS: Fosfomycin could be an alternative treatment option for UTIs related to ESBL-producing E. coli spp. and CA-UTI, but not for ESBL-producing Klebsiella spp. Antimicrobial susceptibilities in ESBL producing UTI was different to UTI classification. Fosfomycin showed decreased sensitivity in HCA-UTI and HA-UTI.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call