SUsceptibility and Resistance to Fosfomycin and other antimicrobial agents among pathogens causing lower urinary tract infections: findings of the SURF study

Michaela Tutone; Truls E. Bjerklund Johansen; Tommaso Cai; Shazad Mushtaq; David M. Livermore

doi:10.1016/j.ijantimicag.2022.106574

SUsceptibility and Resistance to Fosfomycin and other antimicrobial agents among pathogens causing lower urinary tract infections: findings of the SURF study

Michaela Tutone^*, Truls E. Bjerklund Johansen, Tommaso Cai, Shazad Mushtaq, David M. Livermore

^*Corresponding author for this work

UK Health Security Agency

Research output: Contribution to journal › Article › peer-review

18 Citations (Scopus)

139 Downloads (Pure)

Abstract

Urinary tract infections (UTIs) are prevalent worldwide, particularly among women. Their incidence increases with age, and treatment is increasingly challenging owing to antibiotic resistance and the lack of new agents. We investigated the susceptibility of current urinary isolates to fosfomycin and other antibiotics across Europe. This cross-sectional study collected consecutive urinary isolates from non-hospitalised women at 20 centres in Belgium, the UK, Italy, Spain and Russia. Bacteria were tested by disk diffusion with relevant antibiotics. As a quality control, a central laboratory re-tested, by agar dilution, (i) isolates found resistant to fosfomycin and (ii) every tenth isolate; all non-Russian sites were included. A total of 2848 isolates were analysed, principally Escherichia coli (2064; 72.5%), Klebsiella spp. (275; 9.7%) and Proteus spp. (103; 3.6%). For E. coli, agents active against >90% of isolates were nitrofurantoin (98.5%), fosfomycin (96.4%) and mecillinam (91.8%). Fosfomycin and nitrofurantoin remained active against >90% of cephalosporin-resistant E. coli. Among 143 E. coli recorded as susceptible locally by disk tests, 138 (96.5%) were confirmed susceptible by minimum inhibitory concentration (MIC) tests, however resistance was only confirmed in 29/58 (50.0%) of those reported resistant by local disk tests. Escherichia coli was found to be the most common uropathogen isolated and was highly susceptible to fosfomycin, nitrofurantoin and mecillinam, all used effectively for more than 30 years. Guidelines advocating fosfomycin for uncomplicated UTIs in women remain microbiologically valid.

Original language	English
Article number	106574
Journal	International Journal of Antimicrobial Agents
Volume	59
Issue number	5
Early online date	18 Mar 2022
DOIs	https://doi.org/10.1016/j.ijantimicag.2022.106574
Publication status	Published - 5 May 2022

Bibliographical note

Funding Information: This study was entirely supported by Zambon SpA, Italy.

DML has participated on advisory boards or provided ad hoc consultancy for Accelerate, Antabio, Centauri, Entasis, GSK, Integra-Holdings, Meiji, Menarini, Mutabilis, Nordic, Paion, ParaPharm, Pfizer, QPEX, Shionogi, Summit/Discuva, Sumitovant, T.A.Z., VenatoRx, Wockhardt and Zambon, has given paid lectures for bioMérieux, Beckman Coulter, Cardiome, GSK, Hikma, Merck/MSD, Menarini, Nordic, Pfizer and Shionogi. Relevant shareholdings include Dechra, GSK, Merck, Pfizer and Perkin Elmer amounting to less than 10% of portfolio value; share options: T.A.Z. DML also has nominated holdings in Avacta, Diaceutics, Evgen, Faron, Genedrive, Poolbeg, Renalytics, Saietta, Synairgen and Verici through Enterprise Investment Schemes but has no authority to trade these shares directly. TEBJ has been an advisory board member and paid lecturer for Zambon and has received consultancy fees from LMTB (Switzerland), Ferrosan (DK), Borregaard (NO) and research funding from Merck (Cubist) through the European Association of Urology Research Foundation. All other authors declare no competing interests.

Open Access: This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).

Publisher Copyright: © 2022 The Authors. Published by Elsevier Ltd.

Citation: Michaela Tutone, Truls E. Bjerklund Johansen, Tommaso Cai, Shazad Mushtaq, David M. Livermore, SUsceptibility and Resistance to Fosfomycin and other antimicrobial agents among pathogens causing lower urinary tract infections: findings of the SURF study, International Journal of Antimicrobial Agents, Volume 59, Issue 5, 2022, 106574, ISSN 0924-8579.

DOI: https://doi.org/10.1016/j.ijantimicag.2022.106574.

Keywords

Antibiotic susceptibility
Cystitis
Escherichia coli
Fosfomycin trometamol
Urinary tract infection
Uropathogen

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ijantimicag.2022.106574Licence: CC BY

Tutone2022SUsceptibilityAndResistanceToFosfomycinAndOtherAntimicrobialAgentsAmongPathogensIntJAntimicrobAgentsFinal published version, 746 KBLicence: CC BY

Cite this

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title = "SUsceptibility and Resistance to Fosfomycin and other antimicrobial agents among pathogens causing lower urinary tract infections: findings of the SURF study",

abstract = "Urinary tract infections (UTIs) are prevalent worldwide, particularly among women. Their incidence increases with age, and treatment is increasingly challenging owing to antibiotic resistance and the lack of new agents. We investigated the susceptibility of current urinary isolates to fosfomycin and other antibiotics across Europe. This cross-sectional study collected consecutive urinary isolates from non-hospitalised women at 20 centres in Belgium, the UK, Italy, Spain and Russia. Bacteria were tested by disk diffusion with relevant antibiotics. As a quality control, a central laboratory re-tested, by agar dilution, (i) isolates found resistant to fosfomycin and (ii) every tenth isolate; all non-Russian sites were included. A total of 2848 isolates were analysed, principally Escherichia coli (2064; 72.5%), Klebsiella spp. (275; 9.7%) and Proteus spp. (103; 3.6%). For E. coli, agents active against >90% of isolates were nitrofurantoin (98.5%), fosfomycin (96.4%) and mecillinam (91.8%). Fosfomycin and nitrofurantoin remained active against >90% of cephalosporin-resistant E. coli. Among 143 E. coli recorded as susceptible locally by disk tests, 138 (96.5%) were confirmed susceptible by minimum inhibitory concentration (MIC) tests, however resistance was only confirmed in 29/58 (50.0%) of those reported resistant by local disk tests. Escherichia coli was found to be the most common uropathogen isolated and was highly susceptible to fosfomycin, nitrofurantoin and mecillinam, all used effectively for more than 30 years. Guidelines advocating fosfomycin for uncomplicated UTIs in women remain microbiologically valid.",

keywords = "Antibiotic susceptibility, Cystitis, Escherichia coli, Fosfomycin trometamol, Urinary tract infection, Uropathogen",

author = "Michaela Tutone and {Bjerklund Johansen}, {Truls E.} and Tommaso Cai and Shazad Mushtaq and Livermore, {David M.}",

note = "Funding Information: This study was entirely supported by Zambon SpA, Italy. DML has participated on advisory boards or provided ad hoc consultancy for Accelerate, Antabio, Centauri, Entasis, GSK, Integra-Holdings, Meiji, Menarini, Mutabilis, Nordic, Paion, ParaPharm, Pfizer, QPEX, Shionogi, Summit/Discuva, Sumitovant, T.A.Z., VenatoRx, Wockhardt and Zambon, has given paid lectures for bioM{\'e}rieux, Beckman Coulter, Cardiome, GSK, Hikma, Merck/MSD, Menarini, Nordic, Pfizer and Shionogi. Relevant shareholdings include Dechra, GSK, Merck, Pfizer and Perkin Elmer amounting to less than 10% of portfolio value; share options: T.A.Z. DML also has nominated holdings in Avacta, Diaceutics, Evgen, Faron, Genedrive, Poolbeg, Renalytics, Saietta, Synairgen and Verici through Enterprise Investment Schemes but has no authority to trade these shares directly. TEBJ has been an advisory board member and paid lecturer for Zambon and has received consultancy fees from LMTB (Switzerland), Ferrosan (DK), Borregaard (NO) and research funding from Merck (Cubist) through the European Association of Urology Research Foundation. All other authors declare no competing interests. Open Access: This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Publisher Copyright: {\textcopyright} 2022 The Authors. Published by Elsevier Ltd. Citation: Michaela Tutone, Truls E. Bjerklund Johansen, Tommaso Cai, Shazad Mushtaq, David M. Livermore, SUsceptibility and Resistance to Fosfomycin and other antimicrobial agents among pathogens causing lower urinary tract infections: findings of the SURF study, International Journal of Antimicrobial Agents, Volume 59, Issue 5, 2022, 106574, ISSN 0924-8579. DOI: https://doi.org/10.1016/j.ijantimicag.2022.106574.",

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SUsceptibility and Resistance to Fosfomycin and other antimicrobial agents among pathogens causing lower urinary tract infections: findings of the SURF study. / Tutone, Michaela; Bjerklund Johansen, Truls E.; Cai, Tommaso et al.
In: International Journal of Antimicrobial Agents, Vol. 59, No. 5, 106574, 05.05.2022.

Research output: Contribution to journal › Article › peer-review

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AB - Urinary tract infections (UTIs) are prevalent worldwide, particularly among women. Their incidence increases with age, and treatment is increasingly challenging owing to antibiotic resistance and the lack of new agents. We investigated the susceptibility of current urinary isolates to fosfomycin and other antibiotics across Europe. This cross-sectional study collected consecutive urinary isolates from non-hospitalised women at 20 centres in Belgium, the UK, Italy, Spain and Russia. Bacteria were tested by disk diffusion with relevant antibiotics. As a quality control, a central laboratory re-tested, by agar dilution, (i) isolates found resistant to fosfomycin and (ii) every tenth isolate; all non-Russian sites were included. A total of 2848 isolates were analysed, principally Escherichia coli (2064; 72.5%), Klebsiella spp. (275; 9.7%) and Proteus spp. (103; 3.6%). For E. coli, agents active against >90% of isolates were nitrofurantoin (98.5%), fosfomycin (96.4%) and mecillinam (91.8%). Fosfomycin and nitrofurantoin remained active against >90% of cephalosporin-resistant E. coli. Among 143 E. coli recorded as susceptible locally by disk tests, 138 (96.5%) were confirmed susceptible by minimum inhibitory concentration (MIC) tests, however resistance was only confirmed in 29/58 (50.0%) of those reported resistant by local disk tests. Escherichia coli was found to be the most common uropathogen isolated and was highly susceptible to fosfomycin, nitrofurantoin and mecillinam, all used effectively for more than 30 years. Guidelines advocating fosfomycin for uncomplicated UTIs in women remain microbiologically valid.

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KW - Uropathogen

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SUsceptibility and Resistance to Fosfomycin and other antimicrobial agents among pathogens causing lower urinary tract infections: findings of the SURF study

Abstract

Bibliographical note

Keywords

UN SDGs

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