Antimicrobial resistance in enterobacterales recovered from urinary tract infections in France

International audienceIn the context of increasing antimicrobial resistance in Enterobacterales, the management of these UTIs has become challenging. We retrospectively assess the prevalence of antimicrobial resistance in Enterobacterales isolates recovered from urinary tract samples in France, between 1 September 2017, to 31 August 2018. Twenty-six French clinical laboratories provided the susceptibility of 134,162 Enterobacterales isolates to 17 antimicrobials. The most frequent species were $E.\ coli$ (72.0%), $Klebsiella\ pneumoniae$ (9.7%), $Proteus\ mirabilis$ (5.8%), and $Enterobacter\ cloacae$ complex (2.9%). The overall rate of ESBL-producing Enterobacterales was 6.7%, and ranged from 1.0% in $P.\ mirabilis$ to 19.5% in $K.\ pneumoniae$, and from 3.1% in outpatients to 13.6% in long-term care facilities. Overall, 4.1%, 9.3% and 10.5% of the isolates were resistant to cefoxitin, temocillin and pivmecillinam. Cotrimoxazole was the less active compound with 23.4% resistance. Conversely, 4.4%, 12.9%, and 14.3% of the strains were resistant to fosfomycin, nitrofurantoin, and ciprofloxacin. However, less than 1% of E. coli was resistant to fosfomycin and nitrofurantoin. We identified several trends in antibiotics resistances among Enterobacterales isolates recovered from the urinary tract samples in France. Carbapenem-sparing drugs, such as temocillin, mecillinam, fosfomycin, cefoxitin, and nitrofurantoin, remained highly active, including towards ESBL-E

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

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