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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Fosfomycin Susceptibility in Multidrug Resistant Enterobacteriaceae Species and Vancomycin-Resistant Enterococci Urinary Isolates
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Fosfomycin Susceptibility in Multidrug Resistant Enterobacteriaceae Species and Vancomycin-Resistant Enterococci Urinary Isolates

机译：多药抗生素肠杆菌物种和万古霉素耐药肠球菌尿液分离株中的氟哌霉素易感性

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Background: Broad-spectrum antibiotics are often used to treat urinary tract infections (UTIs) due to drug-resistant species of Enterobacteriaceae and Enterococcus (e.g., organisms producing extended-spectrum β-lactamase [ESBL] or AmpC β-lactamase, as well as vancomycin-resistant enterococci [VRE]). However, this type of therapy can promote selection of resistant organisms and may necessitate venous access. Fosfomycin is an orally administered, single-dose antibiotic for the treatment of uncomplicated UTI. Little is known about its microbiologic activity against urinary isolates, including in southwestern Ontario, since fosfomycin susceptibility testing is not routinely performed. Objective: To explore a cost-effective alternative for the treatment of lower UTIs caused by multidrug-resistant Enterobacteriaceae and VRE organisms resistant to usual first-line therapies by determining fosfomycin susceptibility rates. Methods: Urinary isolates were collected prospectively from November 2015 to April 2016 at 3 hospitals in southwestern Ontario. Susceptibility testing was completed according to guidelines of the Clinical and Laboratory Standards Institute, with interpretation by zone of inhibition (as diameter in millimetres). Patients 18 years of age or older with isolation of multidrug-resistant Enterobacteriaceae or VRE were eligible for inclusion. Urinary isolates from these patients were subjected to susceptibility testing. The primary outcome was the rate of fosfomycin susceptibility of these isolates. Results: A total of 137 urinary isolates were tested: 106 positive for ESBL-or AmpC β-lactamase-producing Enterobacteriaceae (95 Escherichia coli, 11 Klebsiella spp.) and 31 positive for vancomycin-resistant Enterococcus faecium. Susceptibility rates for ESBL- and AmpC β-lactamase-producing E. coli were 100% for ertapenem, 96% for fosfomycin, 83% for nitro-furantoin, 72% for gentamicin, 56% for trimethoprim-sulfamethoxazole, and 14% for ciprofloxacin. Susceptibility rates of vancomycin-resistant E. faecium urinary isolates were 100% for linezolid, 81% for fosfomycin, 68% for tetracycline, 6% for ampicillin, 3% for penicillin, and 0% for both nitrofurantoin and ciprofloxacin. Conclusion: Given susceptibility rates at the study institutions, fosfomycin was deemed the most reliable oral option for the treatment of lower UTI in patients with suspected or documented multidrug-resistant uropathogens.
机译：背景：由于肠杆菌科和肠球菌的耐药物种（例如，产生超广谱β-内酰胺酶[ESBL]或AmpCβ-内酰胺酶的微生物，以及耐万古霉素肠球菌[VRE]），广谱抗生素常被用于治疗尿路感染（UTI）。然而，这种类型的治疗可以促进耐药生物体的选择，并可能需要静脉通路。磷霉素是一种口服单剂量抗生素，用于治疗简单的UTI。由于磷霉素药敏试验没有常规进行，因此对其对尿液分离物的微生物学活性知之甚少，包括在安大略省西南部。目的：通过测定磷霉素的药敏率，探索一种治疗由耐多药肠杆菌科和对常用一线治疗耐药的VRE菌引起的下尿路感染的经济有效的替代方法。方法：于2015年11月至2016年4月在安大略省西南部的3家医院前瞻性收集尿液分离菌。药敏试验根据临床和实验室标准研究所的指南完成，并按抑制区（以毫米为单位的直径）进行解释。18岁或以上分离出耐多药肠杆菌科或VRE的患者符合入选条件。对这些患者的尿液分离物进行药敏试验。主要结果是这些菌株对磷霉素的敏感性。结果：共检测137株泌尿系分离物：106株产ESBL或AmpCβ-内酰胺酶的肠杆菌科（95株大肠杆菌，11株克雷伯菌）阳性，31株耐万古霉素屎肠球菌阳性。产ESBL和AmpCβ-内酰胺酶的大肠杆菌对厄他培南的敏感性为100%，对磷霉素的敏感性为96%，对硝基呋喃妥因的敏感性为83%，对庆大霉素的敏感性为72%，对甲氧苄啶磺胺甲恶唑的敏感性为56%，对环丙沙星的敏感性为14%。耐万古霉素的屎肠球菌尿分离株对利奈唑胺的敏感性为100%，磷霉素为81%，四环素为68%，氨苄西林为6%，青霉素为3%，呋喃妥因和环丙沙星均为0%。结论：考虑到研究机构的易感率，磷霉素被认为是治疗疑似或记录在案的多重耐药尿路病原体患者下尿路感染的最可靠口服选择。

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