Is there a rise in resistance rates to fosfomycin and other commonly used antibiotics in Escherichia coli-mediated urinary tract infections? A perspective for 2004 – 2011

Authors: HÜSNÜ PULLUKÇU, SABİRE ŞÖHRET AYDEMİR, MELTEM IŞIKGÖZ TAŞBAKAN, OĞUZ REŞAT SİPAHİ, FATMA FERİHA ÇİLLİ HALL JR, ALPER TÜNGER

Abstract: Resistance patterns of Escherichia coli to fosfomycin, ciprofloxacin, amikacin, and cotrimoxazole were evaluated in 2 different studies held in 2004 and 2005. In this study, it was aimed to compare the changes in the susceptibility patterns of uropathogenic E. coli strains to the above-mentioned antibiotics after 6 years. Materials and methods: Between February and April 2011, E. coli strains isolated from urine samples were included prospectively in the study. Results: A total of 502 E. coli strains (358 from outpatients and 144 from inpatients) were isolated from urine specimens between February and April 2011. Extended spectrum beta-lactamase (ESBL)-producer E. coli rate was 35%. Resistances to cotrimoxazole, ciprofloxacin, amikacin, and fosfomycin were 54.5%, 49.8%, 22.7%, and 1.4%, respectively. When we compared ESBL-producer E. coli strains isolated in 2005 and 2011, amikacin resistance increased (11% to 22.7%, P = 0.0001), whereas cotrimoxazole resistance decreased significantly (74% to 62.9%, P = 0.0063). When we compared resistance patterns of non-ESBL-producer E. coli in relation to 2004 and 2011, there was no significant change in the resistance to fosfomycin, cotrimoxazole, ciprofloxacin, and amikacin. Pooled analysis of fosfomycin studies from Turkey revealed 1.6% fosfomycin resistance in a total of 6439 strains. Conclusion: Our results suggest that despite common usage, there is not an increase in the resistance to fosfomycin. We conclude that fosfomycin can be used as one of the primary choices in the empirical therapy of urinary tract infections.

Keywords: Resistance, fosfomycin, urinary tract infection

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