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Journal Articles Médecine et Maladies Infectieuses Year : 2020

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

1 Hôpital Foch [Suresnes]
2 CHU Nice - Centre Hospitalier Universitaire de Nice
3 Hôpital Henri Mondor
4 Hôpital Bretonneau
5 Hôpital Saint-Louis
6 CHU Reims - Centre Hospitalier Universitaire de Reims
7 AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)
8 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital
9 AP-HP - Hopital Saint-Louis [AP-HP]
10 hpsj - Groupe Hospitalier Paris Saint-Joseph
11 MICALIS - MICrobiologie de l'ALImentation au Service de la Santé
12 Université Paris-Saclay
13 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
14 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
15 HIA - Hopital d'instruction des armées Sainte-Anne [Toulon]
16 CHU Henri Mondor [Créteil]
17 CHU Nantes - Centre hospitalier universitaire de Nantes
18 CHU Poitiers - Centre hospitalier universitaire de Poitiers
19 IGR - Institut Gustave Roussy
20 Département de biologie et pathologie médicales [Gustave Roussy]
21 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
22 Virulence bactérienne précoce : fonctions cellulaires et contrôle de l'infection aiguë et subaiguë
23 CHU Necker - Enfants Malades [AP-HP]
24 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
25 MIVEGEC - Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle
26 HSM - Hydrosciences Montpellier
27 CHV - Centre Hospitalier de Versailles André Mignot
28 Hôpital Avicenne [AP-HP]
29 CHU Caen
30 Centre Hospitalier Universitaire [Rennes]
31 Centre hospitalier [Valenciennes, Nord]
32 Centre hospitalier de Dieppe
33 Hôpital d'Instruction des Armées Begin
E. Riverain
  • Function : Author
V. Fihman
  • Function : Author
C. Le Brun
  • Function : Author
N. Chatelain
  • Function : Author
A. Poisson
  • Function : Author
A. Mizrahi
C. Isnard
  • Function : Author
E. Gyde
  • Function : Author


The fosfomycin breakpoint using the disc diffusion method (DDM) changed in the 2019 CA-SFM/EUCAST guidelines 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 using the DDM and the broth microdilution method (BMD), respectively. The DDM with the 19-mm breakpoint was in accordance with the BMD. Using the 24-mm breakpoint,the overall rate offosfomycin resistance in Enterobacterales increased by three-fold (5.6% vs 18.1%, P < 0.01) and reached 2.8% and 86.5% in E. coli and K. pneumoniae, respectively. French guidelines for the management of community-acquired UTI remain appropriate. 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. coli should be evaluated considering its rate of resistance and recent data reporting low accuracy.

Dates and versions

hal-03471671 , version 1 (08-12-2021)



E. Farfour, N. Degand, E. Riverain, V. Fihman, C. Le Brun, et al.. Fosfomycin, from susceptibility to resistance: Impact of the new guidelines on breakpoints. Médecine et Maladies Infectieuses, 2020, 50 (7), pp 611-616. ⟨10.1016/j.medmal.2020.07.003⟩. ⟨hal-03471671⟩
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