Buscar en
Enfermedades Infecciosas y Microbiología Clínica (English Edition)
Toda la web
Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Prevalence and risk factors for fosfomycin resistance among Escherichia coli str...
Journal Information
Vol. 37. Issue 7.
Pages 484-485 (August - September 2019)
Share
Share
Download PDF
More article options
Vol. 37. Issue 7.
Pages 484-485 (August - September 2019)
Scientific letter
DOI: 10.1016/j.eimce.2018.06.012
Full text access
Prevalence and risk factors for fosfomycin resistance among Escherichia coli strains isolated from males with community febrile urinary tract infection
Prevalencia y factores de riesgo de resistencia a fosfomicina en cepas de Escherichia coli aisladas de hombres con infección del tracto urinario febril comunitaria
Visits
...
Javier Ramosa, Maria Teresa Bastidab, Esther Niñoa, Alex Smithsonc,
Corresponding author
asa30412@hotmail.com

Corresponding author.
a Internal Medicine Department, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
b Microbiology Laboratory, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
c Infectious Diseases Unit, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text
Dear Editor,

Escherichia coli is responsible for most febrile urinary tract infections (FUTI) in men the majority of which are acute prostatitis (AP).1 Fluoroquinolones (FQ) achieve high prostatic concentrations and are considered the first choice in patients with AP.2E. coli is becoming increasingly resistant to FQ limiting its empirical use.3 Given the lack of new antimicrobials it is necessary to reevaluate already existing agents.

Fosfomycin, a bactericidal antibiotic that targets peptidoglycan formation, is active against most E. coli causing FUTI, including extended-spectrum beta-lactamase producing E. coli (ESBL-EC) strains.4 Fosfomycin trometamol achieves reasonable intraprostatic concentrations and has been used in the treatment of chronic prostatitis caused by multidrug-resistant bacteria.5 We aimed to assess the prevalence, trends and risk factors associated to fosfomycin resistance (FR) in E. coli from males with a community FUTI.

An ambispective cross-sectional study was performed at a primary care hospital. Data were recorded retrospectively from January 2008 to October 2009 and prospectively from then to December 2015. FUTI was defined as an armpit temperature ≥38°C together with UTI symptoms. When urinary symptoms were absent, diagnosis was accepted if no other infections were found. Variables reviewed included: age, dementia, diabetes mellitus, chronic kidney or heart failure, cirrhosis, neoplastic or lung disease, use of immunosuppressive agents, the Charlson score, any antibiotic intake in the previous 30 days, prior UTI and existence of urinary abnormalities. A healthcare-associated FUTI was considered in case of: hospitalization in the previous 90 days; residence in a long term care facility; outpatient care, therapy, or invasive urinary tract procedures, 30 days before the FUTI and presence of an indwelling urethral catheter. Urine samples were obtained from midstream urine or from urinary catheters and cultured on MacConkey agar. Positive urine cultures were defined by bacterial growth ≥103CFU/mL. Identification of E. coli was performed by biochemical methods. Antimicrobial susceptibility was tested by agar diffusion (CLSI criteria). Intermediate and resistant strains were grouped together.

The study included 385 males with a community FUTI due to E. coli. Eight (2.1%) isolates were FR and 377 (97.9%) fosfomycin susceptible (FS). Resistance to FQ (p=0.006), amoxicillin–clavulanate (p=0.01), cefuroxime (p=0.03), ceftriaxone (p=0.024) and gentamicin (p=0.015) was more frequent in FR strains. Among the 29 (7.5%) ESBL-EC, 27 (93.1%) were FS. In the univariate analysis FR was associated to older age (p=0.048), dementia (p=0.028) and recent FQ use (p=0.036). The frequency of FR remained stable over the study while there was an increase in the proportion of ESBL-EC (chi square for linear trend 17.4; p<0.001) (Fig. 1).

Fig. 1.

Trends in fosfomycin resistance and ESBL production in E. coli isolated from males with febrile urinary tract infection over the study period.

Abbreviations: R: resistant; ESBL: extended-spectrum beta-lactamase.

(0.05MB).

The overall prevalence of FR was comparable with that previously reported in Spain6 and lower when focusing in ESBL-EC strains.6,7 The low frequency of FR in E. coli despite extensive use of fosfomycin has been attributed to a decreased bacterial fitness.8 However, Spanish studies have suggested the existence of a correlation between fosfomycin consumption and FR in E. coli isolates, mainly in ESBL-EC.6,9 Resistance to fosfomycin is generally related to chromosomal mutations in the target or in the transporter genes and less frequently to plasmid modifying enzymes, mainly the fosA3.4 The fosA3 genes, commonly located on a conjugative plasmid that also carries a CTX-M, are widespread in East Asia.4 A high proportion of the analyzed ESBL-EC strains were susceptible to fosfomycin. Interestingly, only 25% of the FR E. coli isolates were ESBL-EC suggesting that the fosA genes are not spread in our environment. However, this could change in case of dissemination of the fosA3 genes, which have already been detected in Europe.10

We found that older age, dementia and FQ consumption were associated to FR. Nursing home residence has been described as a predictor of FR in ESBL-EC.6 Further studies are required to fully evaluate the risk factors of FR in E. coli.

Our study suggests that FR has not increased over time. Most E. coli isolates were FS including ESBL-EC. Risk factors for FR should be considered when prescribing fosfomycin to males with a FUTI.

References
[1]
P. Ulleryd.
Febrile urinary tract infection in men.
Int J Antimicrob Agents, (2003), pp. 89-93
[2]
B.A. Lipsky, I. Byren, C.T. Hoey.
Treatment of bacterial prostatitis.
Clin Infect Dis, 50 (2010), pp. 1641-1652
[3]
A. Smithson, J. Ramos, M.T. Bastida, S. Bernal, N. Jove, E. Niño, et al.
Differential characteristics of healthcare-associated compared to community acquired febrile urinary tract infections in males.
Eur J Clin Microbiol Infect Dis, 34 (2015), pp. 2395-2402
[4]
S. Sastry, Y. Doi, Fosfomycin:.
Resurgence of an old companion.
J Infect Chemother, 22 (2016), pp. 273-280
[5]
I. Los-Arcos, C. Pigrau, D. Rodríguez-Pardo, N. Fernández-Hidalgo, A. Andreu, N. Larrosa, et al.
Long-term fosfomycin-tromethamine oral therapy for difficult-to-treat chronic bacterial prostatitis.
Antimicrob Agents Chemother, 60 (2015), pp. 1854-1858
[6]
J. Oteo, V. Bautista, N. Lara, O. Cuevas, M. Arroyo, S. Fernández, et al.
Parallel increase in community use of fosfomycin and resistance to fosfomycin in extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli.
J Antimicrob Chemother, 65 (2010), pp. 2459-2463
[7]
C. Rodríguez-Avial, I. Rodríguez-Avial, E. Hernández, J.J. Picazo.
Increasing prevalence of fosfomycin resistance in extended-spectrum-beta-lactamase-producing Escherichia coli urinary isolates (2005–2009–2011).
Rev Esp Quimioter, 26 (2013), pp. 43-46
[8]
A. Pourbaix, F. Guerin, V. Lastours, F. Chau, M. Auzou, E. Boulley, et al.
Biological cost of fosfomycin resistance in Escherichia coli in a murine model of urinary tract infection.
Int J Med Microbiol, 307 (2017), pp. 452-459
[9]
M.Á. Asencio Egea, M. Huertas Vaquero, R. Carranza González, Ó. Herráez Carrera, O. Redondo González, Á. Arias Arias.
Trend and seasonality of community-acquired Escherichia coli antimicrobial resistance and its dynamic relationship with antimicrobial use assessed by ARIMA models.
Enferm Infecc Microbiol Clin, (2017),
[10]
Y. Benzerara, S. Gallah, B. Hommeril, N. Genel, D. Decré, M. Rottman, et al.
Emergence of plasmid-mediated fosfomycin-resistance genes among Escherichia coli isolates, France.
Emerg Infect Dis, 23 (2017), pp. 1564-1567
Copyright © 2018. Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
Article options
Tools
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

es en pt
Política de cookies Cookies policy Política de cookies
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.