Susceptibility profile, resistance mechanisms & efficacy ratios of fosfomycin, nitrofurantoin & colistin for carbapenem-resistant Enterobacteriaceae causing urinary tract infections

Simple item page
dc.contributor.authorAmladi, AUen_US
dc.contributor.authorAbirami, Ben_US
dc.contributor.authorDevi, S, Men_US
dc.contributor.authorSudarsanam, TDen_US
dc.contributor.authorKandasamy, Sen_US
dc.contributor.authorKekre, Nen_US
dc.contributor.authorVeeraraghavan, Ben_US
dc.contributor.authorSahni, RDen_US
dc.date.accessioned2020-04-10T01:41:44Z
dc.date.available2020-04-10T01:41:44Z
dc.date.issued2019-02
dc.description.abstractBackground & objectives: The escalation in carbapenem resistance among Enterobacteriaceae has resulted in a lack of effective therapeutic alternatives. Older antimicrobials, fosfomycin, nitrofurantoin and colistin for urinary tract infections (UTIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) may be effective treatment options. The objectives of this study were to evaluate the utility of fosfomycin, nitrofurantoin and colistin in treating UTI caused by CRE and molecular characterization of the plasmid-mediated carbapenem resistance mechanisms. Methods: Consecutive, non-duplicate isolates of CR Escherichia coli and Klebsiella spp. from urine cultures were included (n=150). Minimum inhibitory concentrations (MIC) were determined by E-test (fosfomycin and nitrofurantoin) and broth microdilution (colistin). Efficacy ratios were derived by dividing susceptibility breakpoints by observed MIC values of the drugs for the isolates. Isolates were screened for genes coding for carbapenemases using multiplex PCR. Fosfomycin, nitrofurantoin and colistin-resistant isolates were screened for plasmid-borne resistance genes fos A3, oqx AB and mcr-1, respectively using PCR. Results: Among E. coli, 98.9, 56 and 95 per cent isolates were susceptible to fosfomycin, nitrofurantoin and colistin, respectively, while 94 and 85 per cent of Klebsiella spp. were susceptible to fosfomycin and colistin, respectively. The efficacy ratios indicated fosfomycin as the drug of choice for UTI caused by CR E. coli and Klebsiella spp., followed by colistin. The blaNDM gene was most common, followed by blaOXA48-like. Plasmid-borne genes encoding resistance to fosfomycin, nitrofurantoin and colistin were absent. Interpretation & conclusions: With increasing resistance against the current treatment options, older drugs may emerge as effective options. Molecular screening of resistant isolates is essential to prevent the spread of plasmid-borne resistance against these drugs.en_US
dc.identifier.affiliationsDepartment of Clinical Microbiology, Christian Medical College, Vellore, Indiaen_US
dc.identifier.affiliationsDepartment of Internal Medicine, Christian Medical College, Vellore, Indiaen_US
dc.identifier.affiliationsDepartment of Intensive Care, Christian Medical College, Vellore, Indiaen_US
dc.identifier.affiliationsDepartment of Urology, Christian Medical College, Vellore, Indiaen_US
dc.identifier.citationAmladi AU, Abirami B, Devi S M, Sudarsanam TD, Kandasamy S, Kekre N, Veeraraghavan B, Sahni RD. Susceptibility profile, resistance mechanisms & efficacy ratios of fosfomycin, nitrofurantoin & colistin for carbapenem-resistant Enterobacteriaceae causing urinary tract infections. Indian Journal of Medical Research. 2019 Feb; 149(2): 185-191en_US
dc.identifier.issn0971-5916
dc.identifier.issn0975-9174
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/195792
dc.languageenen_US
dc.publisherIndian Council of Medical Researchen_US
dc.relation.issuenumber2en_US
dc.relation.volume149en_US
dc.source.urihttps://dx.doi.org/10.4103/ijmr.IJMR_2086_17en_US
dc.subjectCarbapenem-resistant Enterobacteriaceaeen_US
dc.subjectcolistinen_US
dc.subjectfosfomycinen_US
dc.subjectnitrofurantoinen_US
dc.subjecttherapeutic efficacyen_US
dc.titleSusceptibility profile, resistance mechanisms & efficacy ratios of fosfomycin, nitrofurantoin & colistin for carbapenem-resistant Enterobacteriaceae causing urinary tract infectionsen_US
dc.typeJournal Articleen_US
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
ijmr2019v149n2p185.pdf
Size:
488.94 KB
Format:
Adobe Portable Document Format
Download
Collections
Indian Journal of Medical Research