Fosfomycin, from susceptibility to resistance: Impact of the new guidelines on breakpoints

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Farfour, E. | Degand, N. | Riverain, E. | Fihman, V. | Le Brun, C. | Péan de Ponfilly, G. | Muggeo, A. | Jousset, A. | Piau, C. | Lesprit, P. | Chatelain, N. | Dortet, L. | Poisson, A. | Guillard, T. | Limelette, A. | Mizrahi, A. | Le Monnier, Alban | Fournier, D. | Potron, A. | Morand, P. | Janvier, F. | Otto, M.-P. | Woerther, P.-L. | Decousser, J.-W. | Corvec, S. | Plouzeau-Jayle, C. | Broutin, L. | Yin, N. | Héry-Arnaud, G. | Beauruelle, C. | Grillon, Antoine | Lecuru, M. | Bille, E. | Godreuil, S. | Jean Pierre, H. | Jean-Pierre, Hélène | Amara, M. | Henry, A. | Zahar, J.-R. | Carbonelle, E. | Jaureguy, F. | Lomont, A. | Isnard, C. | Cattoir, V. | Canis, F. | Diedrich, T. | Flevin, E. | Merens, A. | Jacquier, H. | Gyde, E.

Edité par CCSD ; Elsevier Masson -

The fosfomycin breakpoint using the disc diffusion method (DDM) changed in the 2019 CA-SFM/EUCASTguidelines v2 (24 mm versus 19 mm).We assessed its impact on categorization of Enterobacterales recovered from urine samples in emergency departments. A total of 7749 and 2348 strains were tested usingthe DDM and the broth microdilution method (BMD), respectively. The DDM with the 19-mm breakpointwas in accordance with the BMD. Using the 24-mm breakpoint,the overall rate offosfomycin resistance inEnterobacterales increased by three-fold (5.6% vs 18.1%, P < 0.01) and reached 2.8% and 86.5% in E. coli andK. pneumoniae, respectively. French guidelines for the management of community-acquired UTI remainappropriate. The accuracy ofthe methods for routine fosfomycin susceptibility testing should be assessed.The role of fosfomycin in the treatment of documented CA-UTI due to Enterobacterales other than E. colishould be evaluated considering its rate of resistance and recent data reporting low accuracy.

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