{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T18:10:41Z","timestamp":1770487841303,"version":"3.49.0"},"reference-count":0,"publisher":"Canadian Society of Healthcare-Systems Pharmacy","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJHP"],"abstract":"<p><strong>ABSTRACT<\/strong><\/p><p><strong>Background:<\/strong> 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 \u00df-lactamase [ESBL] or AmpC \u00df-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.<\/p><p><strong>Objective:<\/strong> 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.<\/p><p><strong>Methods:<\/strong> 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.<\/p><p><strong>Results:<\/strong> A total of 137 urinary isolates were tested: 106 positive for ESBL or AmpC \u00df-lactamase producing Enterobacteriaceae (95 Escherichia coli, 11 Klebsiella spp.) and 31 positive for vancomycin-resistant Enterococcus faecium. Susceptibility rates for ESBL- and AmpC \u00df-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.<\/p><p><strong>Conclusion:<\/strong> 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.<\/p><p><strong>R\u00c9SUM\u00c9<\/strong><\/p><p><strong>Contexte :<\/strong> Les antibiotiques \u00e0 large spectre sont souvent employ\u00e9s pour traiter les infections urinaires caus\u00e9es par des esp\u00e8ces d\u2019ent\u00e9robact\u00e9riac\u00e9es et d\u2019Enterococcus r\u00e9sistantes aux m\u00e9dicaments (par exemple, des organismes qui produisent des \u00df-lactamases \u00e0 spectre \u00e9tendu [BLSE] ou des \u00df-lactamases AmpC de m\u00eame que des ent\u00e9rocoques r\u00e9sistants \u00e0 la vancomycine [ERV]). Or, ce type de traitement peut favoriser la s\u00e9lection d\u2019organismes r\u00e9sistants et peut n\u00e9cessiter un acc\u00e8s veineux. La fosfomycine est un antibiotique oral \u00e0 dose unique servant au traitement d\u2019infections urinaires non compliqu\u00e9es. On conna\u00eet peu de choses sur son activit\u00e9 microbiologique contre les isolats urinaires, en l\u2019occurrence dans le sudouest de l\u2019Ontario, car on ne teste pas syst\u00e9matiquement la fosfomycine dans les antibiogrammes.<\/p><p><strong>Objectif :<\/strong> Chercher une solution ayant un bon rapport co\u00fbt-efficacit\u00e9 pour le traitement des infections urinaires basses caus\u00e9es par des esp\u00e8ces d\u2019ent\u00e9robact\u00e9riac\u00e9es multir\u00e9sistantes aux antibiotiques et des ERV qui ne r\u00e9pondent pas aux traitements de premi\u00e8re intention normalement utilis\u00e9s en d\u00e9terminant les degr\u00e9s de sensibilit\u00e9 \u00e0 l\u2019\u00e9gard de la fosfomycine.<\/p><p><strong>M\u00e9thodes :<\/strong> Des isolats urinaires ont \u00e9t\u00e9 recueillis de fa\u00e7on prospective entre novembre 2015 et avril 2016 dans trois h\u00f4pitaux du sud-ouest de l\u2019Ontario. Des antibiogrammes ont \u00e9t\u00e9 r\u00e9alis\u00e9s selon les lignes directrices du Clinical and Laboratory Standards Institute, et l\u2019interpr\u00e9tation \u00e9tait fond\u00e9e sur la zone d\u2019inhibition (soit le diam\u00e8tre en millim\u00e8tres). Les patients de 18 ans et plus chez qui on avait isol\u00e9 des ent\u00e9robact\u00e9riac\u00e9es ou des ERV multir\u00e9sistants aux antibiotiques \u00e9taient admissibles \u00e0 l\u2019\u00e9tude. Les isolats urinaires provenant de ces patients \u00e9taient soumis \u00e0 un antibiogramme. Le principal param\u00e8tre d\u2019\u00e9valuation \u00e9tait le taux de sensibilit\u00e9 \u00e0 la fosfomycine des isolats urinaires.<\/p><p><strong>R\u00e9sultats :<\/strong> Au total, 137 isolats urinaires ont \u00e9t\u00e9 test\u00e9s; 106 \u00e9taient positifs pour des esp\u00e8ces d\u2019ent\u00e9robact\u00e9ric\u00e9es produisant des BLSE ou des \u00dflactamases AmpC (95 Escherichia coli, 11 esp\u00e8ces de Klebsiella) et 31 \u00e9taient positifs pour l\u2019Enterococcus faecium r\u00e9sistant \u00e0 la vancomycine. Les taux de sensibilit\u00e9 d\u2019E. coli produisant des BLSE et des \u00df-lactamases AmpC \u00e9taient de 100 % pour l\u2019ertap\u00e9nem, 96 % pour la fosfomycine, 83 % pour la nitrofuranto\u00efne, 72 % pour la gentamicine, 56 % pour le co-trimoxazole et 14 % pour la ciprofloxacine. Les taux de sensibilit\u00e9 pour les isolats urinaires d\u2019Enterococcus faecium r\u00e9sistant \u00e0 la vancomycine \u00e9taient de 100 % pour le lin\u00e9zolide, 81 % pour la fosfomycine, 68 % pour la t\u00e9tracycline, 6 % pour l\u2019ampicilline, 3 % pour la p\u00e9nicilline et 0 % pour la nitrofuranto\u00efne et la ciprofloxacine.<\/p><p><strong>Conclusion :<\/strong> En raison des taux de sensibilit\u00e9 obtenus aux \u00e9tablissements \u00e0 l\u2019\u00e9tude, la fosfomycine a \u00e9t\u00e9 jug\u00e9e comme le m\u00e9dicament oral le plus fiable pour le traitement des infections urinaires basses chez les patients pour lesquels la pr\u00e9sence d\u2019uropathog\u00e8nes multir\u00e9sistants aux antibiotiques est soup\u00e7onn\u00e9e ou connue.<\/p><\/jats:p>","DOI":"10.4212\/cjhp.v70i5.1698","type":"journal-article","created":{"date-parts":[[2017,11,6]],"date-time":"2017-11-06T20:29:45Z","timestamp":1510000185000},"source":"Crossref","is-referenced-by-count":3,"title":["Fosfomycin Susceptibility in Multidrug- Resistant Enterobacteriaceae Species and Vancomycin-Resistant Enterococci Urinary Isolates"],"prefix":"10.4212","volume":"70","author":[{"given":"Linda B","family":"Ou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn","family":"Nadeau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2732","published-online":{"date-parts":[[2017,10,30]]},"container-title":["The Canadian Journal of Hospital Pharmacy"],"original-title":[],"link":[{"URL":"http:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/viewFile\/1698\/2634","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/viewFile\/1698\/2651","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/viewFile\/1698\/2651","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2017,11,6]],"date-time":"2017-11-06T20:29:50Z","timestamp":1510000190000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.cjhp-online.ca\/index.php\/cjhp\/article\/view\/1698"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10,30]]},"references-count":0,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2017,10,30]]}},"URL":"https:\/\/doi.org\/10.4212\/cjhp.v70i5.1698","relation":{},"ISSN":["1920-2903","0008-4123"],"issn-type":[{"value":"1920-2903","type":"electronic"},{"value":"0008-4123","type":"print"}],"subject":[],"published":{"date-parts":[[2017,10,30]]}}}