Fosfomycin : An Effective Treatment Modality For Multidrug Resistant Enterobacteriaceae Urinary Tract Infection

Sanjay Pratap Singh; Manish Ranjan; Sourav Sen

Volume : VII, Issue : III, March - 2018

Fosfomycin : An Effective Treatment Modality For Multidrug Resistant Enterobacteriaceae Urinary Tract Infection

Sanjay Pratap Singh, Manish Ranjan, Sourav Sen

Abstract :

Introduction: Urinary tract infections (UTIs) are amongst the commonest types of bacterial infections worldover. There has been rapid emergence and spread of resistance amongst Enterobacteriaceae with multidrug resistant (MDR) and extensively drug resistant (XDR) uropathogens drastically reducing the number of effective drugs for UTI. Fosfomycin is an old oad–spectrum bactericidal antibiotic agent used in the United States and Europe but sp�ly used in India and is not a part of antibiotic recommended for UTI in our National Antibiotic policy. Aim : To evaluate the antibiotic susceptibility profile of MDR Enterobacteriaceae (MDRE) uropathogens and to assess efficacy of Fosfomycin. Methods: A total of 138 non–duplicate urinary isolates of MDR Enterobacteriaceae were included in the study.Identification and susceptibility testing was done according to standard phenotypic microbiological procedures and AST as per recommendations of CLSI.Results: Total number of urine samples processed were 2476, of which 382 samples grew significant Enterobacteriaceae. Of these, 138 isolates were found to be MDR. The common isolates were E. coli (60%) followed by Klebsiella pneumoniae (24%). The rates of resistance to drugs recommended as first line – Nitrofurantoin, trimethoprim–sulfamethoxazole, Ciprofloxacin, Norfloxacin, were 44%, 67%, 72%,and 77% respectively. Sensitivity to Fosfomycin was highest 94.8% . Of 17 Imipenem resistant Enterobacteriaceae (Carbapenem–resistant Enterobacteriaceae), 14 were sensitive to fosfomycin. Conclusion: Fosfomycin sensitivity amongst MDR uropathogens is highest amongst all antimicrobials with convenience of a single–dose regimen for out patients makes it an ideal option for treating MDR UTIs. It is recommended that the Fosfomycin should be kept as a reserve drug for treatment of MDR UTIs. There also appears to be an imperative need to include the same in the National Antibiotic Policy guideline. < clear="all" style="page–eak–before:always;mso–eak–type:section–eak" />