Fosfomycin, from susceptibility to resistance: Impact of the new guidelines on breakpoints - 22/09/20

Doi : 10.1016/j.medmal.2020.07.003

E. Farfour ^a,^⁎ , N. Degand ^b, E. Riverain ^c, V. Fihman ^d, C. Le Brun ^e, G. Péan de Ponfilly ^f, A. Muggeo ^g, A. Jousset ^h, C. Piau ⁱ, P. Lesprit ^a
The GMC study group
N. Chatelain ^j, L. Dortet ^k, A. Poisson ^l, T. Guillard ^m, A. Limelette ^m, A. Mizrahi ⁿ, A. Le Monnier ⁿ, D. Fournier ^o, A. Potron ^o, P. Morand ^p, F. Janvier ^q, M.-P. Otto ^q, P.-L. Woerther ^r, J.-W. Decousser ^r, S. Corvec ^s, C. Plouzeau-Jayle ^t, L. Broutin ^t, N. Yin ^u, G. Héry-Arnaud ^v, C. Beauruelle ^v, A. Grillon ^w, M. Lecuru ^x, E. Bille ^y, S. Godreuil ^z, H. Jean Pierre ^z, M. Amara ^aa, A. Henry ^aa, J.-R. Zahar ^ab, E. Carbonelle ^ab, F. Jaureguy ^ab, A. Lomont ^ab, C. Isnard ^ac, V. Cattoir ^ad, F. Canis ^ae, T. Diedrich ^ae, E. Flevin ^af, A. Merens ^ag, H. Jacquier ^ah, E. Gyde ^ai
^j BioPath, Coquelles, France
^k CHU Bicêtre, Kremlin-Bicêtre, France
^l BioArd’Aisne, Rethel, France
^m CHU de Reims, France
ⁿ Hôpital Paris Saint-Joseph, Paris, France
^o CHU de Besançon, Besançon, France
^p CHU Cochin, Paris, France
^q HIA Sainte-Anne, Toulon, France
^r CHU Henri-Mondor, Créteil, France
^s CHU de Nantes, Nantes, France
^t CHU de Poitiers, Poitiers, France
^u Institut Gustave-Roussy, Nantes, France
^v CHU de Brest, Brest, France
^w CHU de Strasbourg, Strasbourg, France
^x Hôpital Foch, 92150 Suresnes France
^y CHU Necker-Enfants malades, Paris, France
^z CHU de Montpellier, Montpellier, France
^aa CHU de Versailles, Le Chesnay, France
^ab Hôpital Franco-Musulman Avicenne, Bobigny, France
^ac CHU de Caen, Caen, France
^ad CHU de Rennes, Rennes, France
^ae CH de Valencienne, Valencienne, France
^af CH de Dieppe, Dieppe, France
^ag HIA Begin, Saint-Mandé, France
^ah CHU Saint-Louis, Paris, France
^ai CH de Mantes-la-Jolie, Mantes-la-Jolie, France

^a Service de biologie clinique, hôpital Foch, 40, rue Worth, 92150 Suresnes, France
^b Laboratoire de bactériologie, hôpital L’Archet 2, CHU de Nice, Nice, France
^c Service de microbiologie, hôpital F.-Quesnay, Mantes-la-Jolie, France
^d Service de microbiologie, hôpital H.-Mondor, Créteil, France
^e Service de microbiologie, CHU Bretonneau, Tours, France
^f Service de microbiologie, CHU Saint-Louis, Paris, France
^g Service de microbiologie, CHU de Reims, Paris, France
^h Service de microbiologie, CHU Bicêtre, Kremlin-Bicêtre, France
ⁱ Service de microbiologie, CHU Pontchaillou, Rennes, France

^⁎Corresponding author.

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Highlights

•	Fosfomycin is a mainstay for the treatment of community-acquired urinary tract infection (CA-UTI).
•	The fosfomycin breakpoint for Enterobacterales has changed in the 2019 CA-SFM/EUCAST guidelines v2.
•	Using new breakpoints, the overall reported rate of fosfomycin resistance increased by three-fold (5.6% vs 18.1%, P<0.01).
•	In E. coli and K. pneumoniae, the reported rate of fosfomycin resistance reached 2.8% and 86.5%, respectively.
•	The role of fosfomycin in the treatment of documented CA-UTI due to Enterobacterales other than E. coli should be assessed.

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Abstract

The fosfomycin breakpoint using the disc diffusion method (DDM) changed in the 2019 CA-SFM/EUCAST guidelines v2 (24mm versus 19mm). We assessed its impact on categorization of Enterobacterales recovered from urine samples in emergency departments. A total of 7749 and 2348 strains were tested using the DDM and the broth microdilution method (BMD), respectively. The DDM with the 19-mm breakpoint was in accordance with the BMD. Using the 24-mm breakpoint, the overall rate of fosfomycin resistance in Enterobacterales increased by three-fold (5.6% vs 18.1%, P<0.01) and reached 2.8% and 86.5% in E. coli and K. pneumoniae, respectively. French guidelines for the management of community-acquired UTI remain appropriate. The accuracy of the methods for routine fosfomycin susceptibility testing should be assessed. The role of fosfomycin in the treatment of documented CA-UTI due to Enterobacterales other than E. coli should be evaluated considering its rate of resistance and recent data reporting low accuracy.

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Keywords : Fosfomycin, EUCAST, Urinary tract infection, Klebsiella spp.

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Vol 50 - N° 7

P. 611-616 - Ottobre 2020 Ritorno al numero

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Fosfomycin, from susceptibility to resistance: Impact of the new guidelines on breakpoints - 22/09/20

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