Seok Hyeri, Choi Ji Young, Wi Yu Mi, Park Dae Won, Peck Kyong Ran, Ko Kwan Soo
Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea.
Department of Microbiology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea.
Antibiotics (Basel). 2020 Mar 6;9(3):112. doi: 10.3390/antibiotics9030112.
We investigated fosfomycin susceptibility in clinical isolates from South Korea, including community-onset, hospital-onset, and long-term care facility (LTCF)-onset isolates. The resistance mechanisms and genotypes of fosfomycin-resistant isolates were also identified. Finally, the in vitro efficacy of combinations of fosfomycin with other antibiotics were examined in susceptible or extended spectrum β-lactamase (ESBL)-producing isolates. The fosfomycin resistance rate was 6.7% and was significantly higher in LTCF-onset isolates than community-onset and hospital-onset isolates. Twenty-one sequence types (STs) were identified among 19 fosfomycin-resistant isolates, showing diverse genotypes. was found in only two isolates, and diverse genetic variations were identified in three genes associated with fosfomycin resistance, namely, GlpT, UhpT, and MurA. Some fosfomycin-resistant isolates carried no mutations. In vitro time-kill assays showed that fosfomycin alone did not exhibit an excellent killing activity, compared with ciprofloxacin in susceptible isolates and with ertapenem in ESBL producers. However, combining fosfomycin with cefixime or piperacillin-tazobactam eradicated susceptible or ESBL-producing isolates, respectively, even with 0.5× minimum inhibitory concentrations. Overall, we found a relatively high fosfomycin resistance rate in isolates from South Korea. Based on their genotypes and resistance mechanisms, most of the fosfomycin-resistant isolates might occur independently. Antibiotic combinations with fosfomycin could be a suitable therapeutic option for infections caused by isolates.
我们调查了来自韩国的临床分离株对磷霉素的敏感性，包括社区获得性、医院获得性和长期护理机构（LTCF）获得性分离株。还确定了磷霉素耐药分离株的耐药机制和基因型。最后，在敏感或产超广谱β-内酰胺酶（ESBL）的分离株中检测了磷霉素与其他抗生素联合用药的体外疗效。磷霉素耐药率为6.7%，在LTCF获得性分离株中显著高于社区获得性和医院获得性分离株。在19株磷霉素耐药分离株中鉴定出21种序列类型（STs），显示出多样的基因型。仅在两株分离株中发现了[此处原文缺失相关内容]，并且在与磷霉素耐药相关的三个基因（即GlpT、UhpT和MurA）中鉴定出了多样的基因变异。一些磷霉素耐药分离株未携带突变。体外时间杀菌试验表明，与环丙沙星对敏感分离株的作用以及厄他培南对产ESBL分离株的作用相比，单独使用磷霉素未表现出优异的杀菌活性。然而，将磷霉素与头孢克肟或哌拉西林-他唑巴坦联合使用，即使在0.5倍最低抑菌浓度时，也分别根除了敏感或产ESBL的分离株。总体而言，我们发现韩国分离株中磷霉素耐药率相对较高。基于它们的基因型和耐药机制，大多数磷霉素耐药分离株可能是独立出现的。磷霉素联合抗生素可能是治疗由[此处原文缺失相关内容]分离株引起的感染的合适治疗选择。
