Naslov
Cross resistance to fosfomycin in multidrug- resistant Klebsiella pneumoniae

Autori
Bielen, Luka ; Bedenić, Branka ; Slade, Mia ; Siroglavić, Marko ; Varda-Brkić, Dijana ; Tot, Tatjana ; Sardelić, Sanda ; Grgić-Medić, Marijana ; Vukalija-Brajković, Ana

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
ESCMID online abstract library / - , 2018

Skup
28th European congress of clinical microbiology and infectious diseases

Mjesto i datum
Madrid, Španjolska, 21.04.2018. - 24.04.2018

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
fosfomycin ; cross resistance ; Klebsiella pneumoniae ; OXA-48 ; KPC

Sažetak
Background: Due to its broad spectrum of activity, fosfomycin has been extensively studied in recent years. . However, cross resistance to fosfomycin was observed in multidrug-resistant K. pneumoniae including ESBL and carbapenemase positive organisms, during laboratory work. The study hypothesis was that K. pneumoniae isolates with multiresistant and panresistant phenotype producing ESBLs and carbapenemases (KPC, VIM, NDM and OXA-48 β- lactamases) have a greater probability of acquiring resistance to fosfomycin. The aim of the study was to demonstrate that significantly higher percentage of K. pneumoniae isolates with multiresistant and panresistant phenotype is resitant to fosfomycin compared to susceptible strains. Materials/methods: The study was performed on a collection of K. pneumoniae with well defined resistance mechanisms: 4 KPC positive 20 VIM positive, and 40 OXA-48 positive organisms. Nineteen susceptible K. pneumoniae isolates were tested for comparison. The isolates were collected in five hospital centers in Croatia during 2012-2016. In vitro sensitivity of multiresistant bacterial strains to fosfomycin was tested by agar dilution method . Results: The highest frequency of non- sensitive isolates was present among KPC and OXA 48 positive K. pneumoniae isolates (in the latter 15 of 42 isolates were not sensitive). According to CLSI criteria all KPC positive isolates and 9% of MBL positive K. pneumoniae were resistant to fosfomycin. The susceptible strains were uniformly susceptible to fosfomycine whereas 20% of MBL positive strains showed intermediate susceptibility with MIC value of 128 mg/L. IF EUCAST criteria were applied with lower resistance breakpoint (>32 mg/L) there would be 100% of KPC positive strains resistant to fosfomycin, 55% of OXA-48 and 50% of MBL producing organisms. The difference in the in vitro susceptibility between OXA-48 positive isolates and sensitive isolates was found to be statistically significant (Hi square , p=0, 0021, p<0, 01). The difference between ESBL positive and sensitive isolates was close to, but did not reach statistical significance (Hi square p=0, 0511, p>0, 05). Difference between MBL positive and sensitive isolates was statisticaly significant. Conclusions: As K. pneumoniae isolates acquire resistance mechanisms to many groups of antibiotics, including carbapenems, likelyhood of resistance to fosfomycin also increases. Further studies are needed to elucidate the responsible mechanisms.

Izvorni jezik
Engleski

Znanstvena područja
Temeljne medicinske znanosti

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