Correlation between Bactericidal Activity of Fosfomycin Trometamol in an in vitro Model of the Urinary Bladder and Susceptibility Testing

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Abstract
The present study was undertaken to define an interpretative guideline for disk diffusion susceptibility testing with fosfomycin trometamol, a new antimicrobial agent which has been developed for the treatment of urinary tract infections. Two potencies of fosfomycin disk were used: 50 and 200 μg, prepared in the presence and absence of glucose-6-phosphate. To verify the reliability of the results obtained in susceptibility testing, we have also evaluated the bactericidal activity of fosfomycin trometamol versus sensitive and resistant strains in an ‘in vitro’ model simulating the hydrokinetic aspects involved in the treatment of bacterial cystitis. The data obtained evidenced the role of glucose-6-phosphate in antimicrobial susceptibility tests as well as the importance of the urinary antibiotic concentrations to define sensitive and resistant bacteria. On the basis of our results, we recommend that a 200-μg disk of fosfomycin containing 50 μg of glucose-6-phosphate should be used in antimicrobial susceptibility testing with fosfomycin trometamol.

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