Susceptibility Pattern of Fosfomycin Against Drug Resistant Bacteria Obtained from Non - Urinary Clinical Samples in a Tertiary Care Hospital, South India

  • Premalatha Ethirajulau Department of Microbiology, Tagore Medical College & Hospital, Affiliated to Tamilnadu DR MGR Medical University
  • Jeyakumari Duraipandian Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal. Affiliated to DGHS, Ministry of Health and family welfare
  • Kandasamy Sankararaman Department of Microbiology, Tagore Medical College & Hospital, Affiliated to Tamilnadu DR MGR Medical University
  • Sony Mary Paul Department of Microbiology, Tagore Medical College & Hospital, Affiliated to Tamilnadu DR MGR Medical University
  • Priestly Vivekkumar Department of Pharmacology, Tagore Medical College & Hospital, Affiliated to Tamilnadu DR MGR Medical University
  • Sukumar Rathnamgiri Department of Microbiology, Tagore Medical College & Hospital, Affiliated to Tamilnadu DR MGR Medical University
DOI: https://doi.org/10.21276/apalm.1737
Keywords: Fosfomycin, MRSA, ESBL E.coli, ESBL Klebsiella, MBL Pseudomonas aeruginosa, Disc – diffusion, Agar dilution.

Abstract

Background: Multi drug resistance (MDR) in bacterial infections has been an ever growing problem worldwide. To combat this some of the old drugs like fosfomycin used in the past are revived. The aim of our study was to determine the susceptibility of fosfomycin against Methicillin sensitive and Resistant Staphylococcus aureus, ESBL producing Escherichia coli, Klebsiella species and Metallo Beta Lactamase producing Pseudomonas aeruginosa isolated from the specimens other than urine and to evaluate the agreement between the two methods, disk diffusion and agar dilution methods performed as per CLSI guidelines.   Methods: First isolate of each species per patient (n=250) were tested for susceptibility to fosfomycin concomitantly by the disk diffusion and agar dilution methods described by CLSI guidelines and comparison of the two methods were studied. Result: Staphylococcus aureus and ESBL E. coli were showing 100% susceptibility, Whereas ESBL producing Klebsiella species showed 88% susceptibility to fosfomycin 200 µg/disc and 80% and 72% by agar dilution method as per CLSI and EUCAST criteria. For MBL producing Pseudomonas aeruginosa, 90% isolates were susceptible to fosfomycin 200 µg/disc and in agar dilution (60%) (≤32µg/ml) were susceptible as per EUCAST criteria. Disk diffusion method showed good agreement for S.aureus and E.coli whereas moderate agreement for Klebsiella species and very poor for Pseudomonas aeruginosa. Conclusion: Fosfomycin can be considered as an alternate drug to treat infections with multi drug resistant bacteria, not only for the UTI but for systemic infections also. This is achievable with establishment of breakpoint values and zone diameter for all common isolates.

References

1. Magiorakos A P, Srinivasan A, Carey RB, Carmeli, Y, Falagas, M.E.,Giske,C.G, etal. Multi drug resistant, extensively drug resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18:268-81.
2. Gupta k. Emerging antibiotic resistance in urinary tract pathogens. Infect Dis Clin North Am 2003; 17:243-59.
3. Falgas ME, Polemis M, Alexious VG, Marini – Mastrogiammaki A, Kremastinou j, Vatopoulos AC. Antimicrobial resistance of Escherichia coli urinary isolates from primary care patients in Greece. Med Sci Monit 2008; 14: 75-79.
4. Boucher HW, Talbot GH, Bradley JS, Edwards, J.E., Gilbert D, Rice L.B, etal. Bad bugs, no drugs: no ESKAPE! An update from the infectious diseases society of America. Clin Infect Dis 2009; 48:1-12.
5. Appelbaum PC. 2012 and beyond: potential for the start of a second pre-antibiotic era? J Antimicrob Chemother. 2012; 67:2062-68.
6. Raz R. Fosfomycin an old new antibiotic. Clin Microbiol Infect 2012; 18: 4-7.
7. Popovic M, Sreinort D, Pillai S, Joukhadar C. Fosfomycin: an old, new friend? Eur J Clin Microbiol Infect Dis 2010; 29:127-42.
8. Falgas ME, Kastoris AC, Karageorgopoulos DE, Rafailidis PI. Fosfomycin for the treatment of infections caused by multidrug non – fermenting gram negative bacilli. A systematic review of microbiological, animal and clinical studies. Int J Antimicrob Agents 2009; 34: 111- 20.
9. Falgas ME, Kastoris AC, Kapaskelis AM, Karageorgopoulos DE. Fosfomycin for the treatment of multidrug – resistant including extended spectrum beta – lactamase producing Enterobacteriaceae infections: a systematic review. Lancet Infect Dis 2010; 10: 43- 50.
10. De cueto M, Lopez L, Hernandez JR, Morillo C, Pascual A. In vitro activity of fosfomycin against Extended - Spectrum - β - Lactamase- producing Escherichia coli and Klebsiella pneumoniae:comparison of susceptibility testing procedures. Antimicrob Agents Chemother 2006; 50:368 - 70.
11. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing 27th ed. CLSI supplement M100, Clinical and Laboratory Standards Institute, Wayne, PA. 2017.
12. Pitout JDP, Gregson DB, Poirel I, McClure JA, Le P, Chruch DL. Detection of Pseudomonas aeruginosa producing metallo – beta lactamases in a large central laboratory. J Clin Microbiol 2005; 43:3129-35.
13. Helene G., Laurence D.R, Jean- Louis G, Vincent J, Jerome, R. Comparison of Nine Phenotypic Methods for Detection of Extended- Spectrum β - Lactamase production by Enterobacteriaceae. J.Clin.Microbiol 2011; 49: 1048 -57.
14. European Committee on Antimicrobial Susceptibility Testing. 13 December 2009. European Committee on Antimicrobial Susceptibility Testing. http: //www.eucast.org. Accessed 20 June 2017.
15. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33:159-74. http://dx.doi.org/10.2307/2529310
16. Falgas ME, Giannopoulou KP, Kakolakis GH, Rafailidis, P.I. Fosfomycin use beyond urinary tract and gastrointestinal infections. Clin Infect Dis 2008; 46:1069-77.
17. Yao JDC, Moellering Jr RC. Antibacterial agents In: Murray PR, Bacon EJ, Jorgensen JH etal. Eds., Manual of clinical microbiology. 9th ed. Washington. ASM Press. 2007.
18. Karadag A, Cayci YT, Bilgin k, Gunaydin M, Eroglu, C. In vitro efficacy of fosfomycin against clinical strains. JMID 2014; 4: 55-58.
19. Yu xH, Song XJ, Cai Y, Liang BB, Lin DF, Wang R. In vitro activity of two old antibiotics against clinical isolates of Methicillin-Resistant Staphylococcus aureus. J Antibiot 2010; 63: 497 -99.
20. Poeppl W, Tabudic S, Lingscheid T, Plasenzotti R, Kozakowski N, Georgopoulos A, etal. Efficacy of fosfomycin in experimental osteomyelitis due to methicillin resistant Staphylococcus aureus. Antimicrob Agents Chemother 2011; 55:931-33.
21. Falagas ME, Maraki S, Karageorgopoulos DE, Kastoris AC, kapaskelis A, Samonis G. Antimicrobial susceptibility of gram positive non-urinary isolates of fosfomycin. Int J Antimicrob Agents 2010; 35:497-99.
22. Lu CI, Ltu CY, Huang YT, Liao CH, Teng LJ, Turnidge JD, Hsuech PR. Antimicrobial susceptibilities of commonly encountered bacterial isolates of fosfomycin determined by agar dilution and disk diffusion methods. Antimicrob Agents Chemother 2011; 55: 4295-301. http://dx.doi.org 10.1128/AAC00349-11.
23. Oksuz L, Dupieux C, Tristan A, Bes M, Etienne J, Gurler N. The high diversity of MRSA clones detected in a university hospital in Istanbul. Int J med Sci 2013; 10: 1740-45.
24. Pullukcu H, Tasbakan M, Sipahi OR, Yamazhan T, Aydemir S, Ulusoy S. Fosfomycin in the treatment of extended spectrum beta lactamase producing Escherichiae coli related lowerurinary tract infections. Int J Antimicrob Agents 2007; 29: 62 -65.
25. Endimiani A, Patel G, Hujer KM, Swaminathan M, Perez F, Rice LB, etal. In vitro activity of fosfomycin against blakpc- containing klebsiella pneumonia isolates including those non- susceptible to tigecycline and or/colistin. Antimicrob Agents. Chemother 2010; 54:526- 29.
26. Tharavichitkul P, Khantawa B, Bousoung V, Boonchoo M. Activity of fosfomycin against extended – spectrum beta lactamase producing Klebsiella pneumoniae and Escherichia coli in Mahoney Nakom Chiang Mai Hospital. J Infect Dis Antimicrob Agents 2005; 22: 125-26.
27. Chitra C, Kumar DRN, Shakti L, Diana SK, Balaji V. Technical and interpretative issues of fosfomycin susceptibility testing. IJMM 2015; 33:611-12.
28. Kasse M, Szabados F, Anders A, Gaterman SG. Fosfomycin susceptibility in Carbapenem – Resistant Enterobacteriaceae from Germany. J Clin Microbiol 2014; 52:1893-97.
29. Perdigao – Neto LV, Oliveira MS, Rizek CF, Carrilho CM, Costa SF, Levin AS. Susceptibility of multiresitant gram negative bacteria to fosfomycin and performance of different susceptibility testing methods. Antimicrob Agents Chemother 2014; 58:1763-67.
30. Falagas ME, Marakis, Karageorgopoulos DE, Kastoris AC, Mavromanolakis E, Samonis G. Antimicrobial susceptibility of mluti- drug resistant (MDR) and extensively drug resistant (XDR) enterobactericeae isolates to fosfomycin. Int J Antimicrob Agents 2010; 35:240-43.
Published
2018-05-20
Issue
Vol 5 No 5 (2018)
Section
Original Article

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