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83 Fosfomycin activity versus carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococcus (VRE) at the Detroit Medical Center (DMC)

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Jason M. Pogue, PharmD , Detroit Medical Center, Wayne State University, Detroit, MI
Dror Marchaim, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Ryan P. Mynatt, PharmD , Detroit Medical Center, Wayne State University, Detroit, MI
Jing J. Zhao, PharmD , Detroit Medical Center, Wayne State University, Detroit, MI
Odaliz Abreu-Lanfranco, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Suchitha Bheemreddy, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Bharath Sunkara, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Kayoko Hayakawa, MD, PhD , Detroit Medical Center, Wayne State University, Detroit, MI
Teena Chopra, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Sorabh Dhar, MD , Detroit Medical Center, Wayne State University, Detroit, MI
Keith S. Kaye, MD, MPH , Detroit Medical Center, Wayne State University, Detroit, MI
Paul R. Lephart, PhD , Detroit Medical Center, Wayne State University, Detroit, MI
Background: CRE and VRE are multi-drug resistant (MDR) endemic pathogens in many US hospitals. Treatment options for these pathogens are extremely limited and often require broad-spectrum agents. Fosfomycin is an “old” antimicrobial approved in the US in an oral formulation for the treatment of urinary tract infections (UTI).

Objective: We conducted this microbiological analysis to determine the susceptibility of CRE and VRE to fosfomycin within our healthcare system.

Methods: From 09/2008 through 10/2009, 93 unique CRE isolates and 70 unique VRE isolates were tested via Etest (AB Biodisk®, Solna, Sweden) for susceptibility to fosfomycin. Breakpoints to define susceptibility were based on Clinical and Laboratory Standards Institute’s (CLSI) criteria or on The European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria when CLSI criteria were not available.

Results: Fosfomycin susceptibility (MIC ≤ 64 mcg/mL) was seen in 79/93 (85%) of CRE isolates [27/35 (78%) of the urinary isolates), and 60/70 (86%) of VRE isolates [27/35 (78%) of the urinary isolates]. Compared to other potential treatments for CRE, fosfomycin displayed a higher degree of susceptibility when compared to colistin (82% were susceptible, MIC ≤ 2 mcg/mL) or tigecycline (81% were susceptible, MIC ≤ 2 mcg/mL). The susceptibly rate of other potential agents to treat VRE during the same study period was 95% for daptomycin (MIC ≤4 mcg/mL) and 98% (MIC ≤2 mcg/mL) for linezolid.

Conclusions: Fosfomycin displayed good activity against CRE and VRE. Fosfomycin may have an important role in antimicrobial stewardship efforts for the treatment of uncomplicated UTI secondary to CRE or VRE. Utilization of this agent might decrease reliance on other broad-spectrum agents and reserve them for systemic infections.