Evaluating The Role of Fosfomycin in Treating MDR Urinary Pathogens: A Tertiary Care Hospital Perspective

Urinary tract infections (UTIs) are most common infections encountered in both community and hospital settings and are frequently treated with antibiotics. Escherichia coli and Klebsiella pneumoniae, members of the Enterobacteriaceae family, are the predominant uropathogens. The rise of resistant uropathogens, that exhibit significant rates of antibiotic resistance, is making therapy more demanding. Increasing usage of carbapenem in complicated urinary infections is resulting in the Carbapenem-resistant escalation property in the gram-negative bacilli. This research was done to assess in vitro susceptibility of fosfomycin against both uropathogenic E. coli and K. pneumoniae. Over an interval of three months, 1070 urine samples were processed (January to March 2024). After an exclusion criteria, 1000 Specimens were inoculated on blood and Macconkey agar and incubated at 37 °C. Microbial growth and colony counts were noted. Speciation and antibiotic sensitivity pattern were analysed using Automated compact system of VITEK 2 (BioMerieux Inc., France). Fosfomycin discs were used to determine CRE and ESBL producers. Overall, 99.43% of E. coli isolates were susceptible to fosfomycin. E. coli that produce carbapenemase and ESBL had a fosfomycin susceptibility of 99.17% and 98.78%, respectively. The overall fosfomycin susceptibility of K. pneumoniae is 91.30%. Fosfomycin is effective against 91.6% and 87.5% of the carbapenem-resistant and ESBL-producing strains of K. pneumoniae, respectively. Although fosfomycin resistance is currently low, it may be a therapeutic alternative relative to other medications used for the management of UTIS caused by ESBL and carbapenem-resistant E. coli and K. pneumoniae. To preserve the efficacy of fosfomycin it must be used carefully following antimicrobial stewardship principles and guidelines.