{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T07:00:36Z","timestamp":1789801236196,"version":"4.0.1"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2022,8,16]],"date-time":"2022-08-16T00:00:00Z","timestamp":1660608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100010318","name":"University of Manitoba","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100010318","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Health Sciences Centre"},{"name":"Public Health Agency of Canada \u2013 National Microbiology Laboratory"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multiple susceptible breakpoints are published to interpret fosfomycin MICs: \u226464\u2005mg\/L for Escherichia coli and Enterococcus faecalis grown from urine (CLSI M100); \u226432\u2005mg\/L for Enterobacterales and staphylococci when parenteral fosfomycin is prescribed (EUCAST); and \u22648\u2005mg\/L for uncomplicated urinary tract infection with E. coli when oral fosfomycin is used (EUCAST). Clinical laboratories are frequently requested to test fosfomycin against antimicrobial-resistant urinary isolates not included in standard documents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The in vitro activity of fosfomycin was determined using the CLSI agar dilution method for a 2007\u201320 collection of clinically significant Gram-negative (3656 Enterobacterales; 140 Pseudomonas aeruginosa) and Gram-positive (346 E. faecalis; 94 Staphylococcus aureus) urinary isolates from the CANWARD surveillance study. Comparator agents were tested using CLSI broth microdilution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Using the CLSI MIC breakpoint (\u226464\u2005mg\/L), 99.2% of E. coli (n\u200a=\u200a2871; MIC90, 4\u2005mg\/L), including 96.7% of ESBL-positive isolates, were fosfomycin susceptible. Similarly, 95.8% of E. coli, including 95.2% of ESBL-positive isolates, were fosfomycin susceptible at \u22648\u2005mg\/L (EUCAST oral susceptible MIC breakpoint). All other species of Enterobacterales (except Citrobacter freundii) and P. aeruginosa had higher fosfomycin MICs (MIC90s, 64 to &amp;gt;512\u2005mg\/L) than E. coli. Using published breakpoints, 88.4% of E. faecalis (MIC \u226464\u2005mg\/L) and 97.9% of S. aureus (MIC \u226432\u2005mg\/L) isolates were fosfomycin susceptible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Fosfomycin demonstrated in vitro activity against frequently encountered Gram-positive and Gram-negative urinary pathogens; however, the extrapolation of current CLSI and EUCAST MIC breakpoints to pathogens not specified by standard methods requires further study and is currently not recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkac275","type":"journal-article","created":{"date-parts":[[2022,8,16]],"date-time":"2022-08-16T03:47:30Z","timestamp":1660621650000},"page":"3035-3038","source":"Crossref","is-referenced-by-count":14,"title":["<i>In vitro<\/i>\n                    activity of fosfomycin against bacterial pathogens isolated from urine specimens in Canada from 2007 to 2020: CANWARD surveillance study"],"prefix":"10.1093","volume":"77","author":[{"given":"James A","family":"Karlowsky","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba , Winnipeg , Canada"},{"name":"Clinical Microbiology, Diagnostic Services, Shared Health Manitoba , Winnipeg , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie R","family":"Baxter","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba , Winnipeg , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J","family":"Walkty","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba , Winnipeg , Canada"},{"name":"Clinical Microbiology, Diagnostic Services, Shared Health Manitoba , Winnipeg , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe R S","family":"Lagac\u00e9-Wiens","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba , Winnipeg , Canada"},{"name":"Clinical Microbiology, Diagnostic Services, Shared Health Manitoba , Winnipeg , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3620-828X","authenticated-orcid":false,"given":"Denice","family":"Bay","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba , Winnipeg , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather J","family":"Adam","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba , Winnipeg , Canada"},{"name":"Clinical Microbiology, Diagnostic Services, Shared Health Manitoba , Winnipeg , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George G","family":"Zhanel","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba , Winnipeg , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,16]]},"reference":[{"key":"2022102819180952300_dkac275-B1","doi-asserted-by":"crossref","DOI":"10.1155\/2016\/2082693","article-title":"Fosfomycin: a first-line oral therapy for acute uncomplicated cystitis","volume":"2016","author":"Zhanel","year":"2016","journal-title":"Can J Infect Dis Med 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Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases","volume":"52","author":"Gupta","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2022102819180952300_dkac275-B6","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.01306-20","article-title":"Susceptibility of clinical isolates of Escherichia coli to fosfomycin as measured by four in vitro testing methods","volume":"58","author":"Karlowsky","year":"2020","journal-title":"J Clin Microbiol"},{"key":"2022102819180952300_dkac275-B7","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing\u2014Thirty-Second Edition: M100","author":"CLSI","year":"2022"},{"key":"2022102819180952300_dkac275-B8","author":"EUCAST","year":"2022"},{"key":"2022102819180952300_dkac275-B9","author":"CLSI","year":"2018"},{"key":"2022102819180952300_dkac275-B10","author":"EUCAST"},{"issue":"Suppl 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