Scientific letter
Prevalence and risk factors for fosfomycin resistance among Escherichia coli strains isolated from males with community febrile urinary tract infection
Prevalencia y factores de riesgo de resistencia a fosfomicina en cepas de Escherichia coli aisladas de hombres con infección del tracto urinario febril comunitaria
a Internal Medicine Department, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
b Microbiology Laboratory, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
c Infectious Diseases Unit, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
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"Alto" => 1174 "Ancho" => 2493 "Tamanyo" => 176526 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Serum potassium determinations for the three cases.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Toro Blanch, Laura Gratacós Santanach, Cristina Díez Vallejo, Rosa Sacrest Güell" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Toro Blanch" ] 1 => array:2 [ "nombre" => "Laura" "apellidos" => "Gratacós Santanach" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "Díez Vallejo" ] 3 => array:2 [ "nombre" => "Rosa" "apellidos" => "Sacrest Güell" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213005X1830226X" "doi" => "10.1016/j.eimc.2018.06.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => 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"apellidos" => "Ramos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Maria Teresa" "apellidos" => "Bastida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Esther" "apellidos" => "Niño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:4 [ "nombre" => "Alex" "apellidos" => "Smithson" "email" => array:1 [ 0 => "asa30412@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Internal Medicine Department, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Microbiology Laboratory, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Infectious Diseases Unit, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia y factores de riesgo de resistencia a fosfomicina en cepas de <span class="elsevierStyleItalic">Escherichia coli</span> aisladas de hombres con infección del tracto urinario febril comunitaria" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 881 "Ancho" => 1210 "Tamanyo" => 48135 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Trends in fosfomycin resistance and ESBL production in <span class="elsevierStyleItalic">E. coli</span> isolated from males with febrile urinary tract infection over the study period.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: R: resistant; ESBL: extended-spectrum beta-lactamase.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Escherichia coli</span> is responsible for most febrile urinary tract infections (FUTI) in men the majority of which are acute prostatitis (AP).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Fluoroquinolones (FQ) achieve high prostatic concentrations and are considered the first choice in patients with AP.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleItalic">E. coli</span> is becoming increasingly resistant to FQ limiting its empirical use.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Given the lack of new antimicrobials it is necessary to reevaluate already existing agents.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Fosfomycin, a bactericidal antibiotic that targets peptidoglycan formation, is active against most <span class="elsevierStyleItalic">E. coli</span> causing FUTI, including extended-spectrum beta-lactamase producing <span class="elsevierStyleItalic">E. coli</span> (ESBL-EC) strains.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Fosfomycin trometamol achieves reasonable intraprostatic concentrations and has been used in the treatment of chronic prostatitis caused by multidrug-resistant bacteria.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> We aimed to assess the prevalence, trends and risk factors associated to fosfomycin resistance (FR) in <span class="elsevierStyleItalic">E. coli</span> from males with a community FUTI.</p><p id="par0015" class="elsevierStylePara elsevierViewall">An ambispective cross-sectional study was performed at a primary care hospital. Data were recorded retrospectively from January 2008 to October 2009 and prospectively from then to December 2015. FUTI was defined as an armpit temperature ≥38<span class="elsevierStyleHsp" style=""></span>°C together with UTI symptoms. When urinary symptoms were absent, diagnosis was accepted if no other infections were found. Variables reviewed included: age, dementia, diabetes mellitus, chronic kidney or heart failure, cirrhosis, neoplastic or lung disease, use of immunosuppressive agents, the Charlson score, any antibiotic intake in the previous 30 days, prior UTI and existence of urinary abnormalities. A healthcare-associated FUTI was considered in case of: hospitalization in the previous 90 days; residence in a long term care facility; outpatient care, therapy, or invasive urinary tract procedures, 30 days before the FUTI and presence of an indwelling urethral catheter. Urine samples were obtained from midstream urine or from urinary catheters and cultured on MacConkey agar. Positive urine cultures were defined by bacterial growth ≥10<span class="elsevierStyleSup">3</span><span class="elsevierStyleHsp" style=""></span>CFU/mL. Identification of <span class="elsevierStyleItalic">E. coli</span> was performed by biochemical methods. Antimicrobial susceptibility was tested by agar diffusion (CLSI criteria). Intermediate and resistant strains were grouped together.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The study included 385 males with a community FUTI due to <span class="elsevierStyleItalic">E. coli</span>. Eight (2.1%) isolates were FR and 377 (97.9%) fosfomycin susceptible (FS). Resistance to FQ (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006), amoxicillin–clavulanate (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01), cefuroxime (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.03), ceftriaxone (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.024) and gentamicin (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.015) was more frequent in FR strains. Among the 29 (7.5%) ESBL-EC, 27 (93.1%) were FS. In the univariate analysis FR was associated to older age (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.048), dementia (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.028) and recent FQ use (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.036). The frequency of FR remained stable over the study while there was an increase in the proportion of ESBL-EC (chi square for linear trend 17.4; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The overall prevalence of FR was comparable with that previously reported in Spain<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and lower when focusing in ESBL-EC strains.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> The low frequency of FR in <span class="elsevierStyleItalic">E. coli</span> despite extensive use of fosfomycin has been attributed to a decreased bacterial fitness.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> However, Spanish studies have suggested the existence of a correlation between fosfomycin consumption and FR in <span class="elsevierStyleItalic">E. coli</span> isolates, mainly in ESBL-EC.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,9</span></a> Resistance to fosfomycin is generally related to chromosomal mutations in the target or in the transporter genes and less frequently to plasmid modifying enzymes, mainly the <span class="elsevierStyleItalic">fosA3</span>.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The <span class="elsevierStyleItalic">fosA3</span> genes, commonly located on a conjugative plasmid that also carries a CTX-M, are widespread in East Asia.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> A high proportion of the analyzed ESBL-EC strains were susceptible to fosfomycin. Interestingly, only 25% of the FR <span class="elsevierStyleItalic">E. coli</span> isolates were ESBL-EC suggesting that the <span class="elsevierStyleItalic">fosA</span> genes are not spread in our environment. However, this could change in case of dissemination of the <span class="elsevierStyleItalic">fosA3</span> genes, which have already been detected in Europe.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We found that older age, dementia and FQ consumption were associated to FR. Nursing home residence has been described as a predictor of FR in ESBL-EC.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Further studies are required to fully evaluate the risk factors of FR in <span class="elsevierStyleItalic">E. coli</span>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Our study suggests that FR has not increased over time. Most <span class="elsevierStyleItalic">E. coli</span> isolates were FS including ESBL-EC. Risk factors for FR should be considered when prescribing fosfomycin to males with a FUTI.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 881 "Ancho" => 1210 "Tamanyo" => 48135 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Trends in fosfomycin resistance and ESBL production in <span class="elsevierStyleItalic">E. coli</span> isolated from males with febrile urinary tract infection over the study period.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>: R: resistant; ESBL: extended-spectrum beta-lactamase.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Febrile urinary tract infection in men" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 5 | 4 | 9 |
| 2024 September | 10 | 17 | 27 |
| 2024 August | 18 | 15 | 33 |
| 2024 July | 7 | 8 | 15 |
| 2024 June | 4 | 4 | 8 |
| 2024 May | 11 | 7 | 18 |
| 2024 April | 15 | 4 | 19 |
| 2024 March | 17 | 5 | 22 |
| 2024 February | 10 | 1 | 11 |
| 2024 January | 6 | 3 | 9 |
| 2023 December | 9 | 4 | 13 |
| 2023 November | 11 | 3 | 14 |
| 2023 October | 21 | 2 | 23 |
| 2023 September | 8 | 1 | 9 |
| 2023 August | 14 | 2 | 16 |
| 2023 July | 9 | 3 | 12 |
| 2023 June | 13 | 6 | 19 |
| 2023 May | 21 | 4 | 25 |
| 2023 April | 36 | 7 | 43 |
| 2023 March | 10 | 4 | 14 |
| 2023 February | 20 | 4 | 24 |
| 2023 January | 52 | 8 | 60 |
| 2022 December | 23 | 5 | 28 |
| 2022 November | 29 | 11 | 40 |
| 2022 October | 27 | 17 | 44 |
| 2022 September | 12 | 16 | 28 |
| 2022 August | 8 | 7 | 15 |
| 2022 July | 16 | 6 | 22 |
| 2022 June | 11 | 9 | 20 |
| 2022 May | 25 | 7 | 32 |
| 2022 April | 15 | 7 | 22 |
| 2022 March | 22 | 10 | 32 |
| 2022 February | 57 | 5 | 62 |
| 2022 January | 40 | 7 | 47 |
| 2021 December | 39 | 6 | 45 |
| 2021 November | 27 | 10 | 37 |
| 2021 October | 55 | 12 | 67 |
| 2021 September | 43 | 10 | 53 |
| 2021 August | 37 | 5 | 42 |
| 2021 July | 13 | 8 | 21 |
| 2021 June | 10 | 8 | 18 |
| 2021 May | 24 | 10 | 34 |
| 2021 April | 56 | 7 | 63 |
| 2021 March | 14 | 7 | 21 |
| 2021 February | 9 | 5 | 14 |
| 2021 January | 13 | 12 | 25 |
| 2020 December | 9 | 5 | 14 |
| 2020 November | 9 | 2 | 11 |
| 2020 October | 7 | 2 | 9 |
| 2020 September | 9 | 10 | 19 |
| 2020 August | 6 | 4 | 10 |
| 2020 July | 5 | 6 | 11 |
| 2020 June | 7 | 10 | 17 |
| 2020 May | 5 | 9 | 14 |
| 2020 April | 3 | 2 | 5 |
| 2020 March | 12 | 7 | 19 |
| 2020 February | 10 | 2 | 12 |
| 2020 January | 1 | 3 | 4 |
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