Journal of Antimicrobial Chemotherapy (1999) 43, 211-217
© 1999 The British Society for Antimicrobial Chemotherapy
In-vitro activity of fosfomycin against vancomycin-resistant enterococci
a Institute of Hygiene, Fritz Pregl Strasse 3, A-6020 Innsbruck, Austria; b Robert Koch Institute, Burgstrasse 37, D-38855 Wernigerode, Germany
The effect of fosfomycin against 69 vancomycin-resistant isolates of Enterococcus faecium (VanA), five of E. faecium (VanB), 11 of Enterococcus faecalis (VanA),
three of E. faecalis (VanB), 10 of Enterococcus gallinarum (VanC1
) and two of Enterococcus casseliflavus (VanC2) and glycopeptide-sensitive
E. faecium (n = 8) and E. faecalis (n = 10)
was tested in vitro. Fosfomycin inhibited 97%, 94% and 96% of the
vancomycin-resistant strains, according to results of agar dilution, broth microdilution, and a disc
diffusion method (DIN 58940). The disc diffusion test by the NCCLS method does not include
fosfomycin; using breakpoints suggested by Andrews et al. ( 
11 mm, resistant;
18 mm, susceptible), 5% of the vancomycin-resistant strains tested would have been considered
fosfomycin resistant.
Minimal inhibitory concentrations of most vancomycin-resistant isolates were in the intermediate
sensitivity range, yielding an MIC50
of 32 mg/L and an MIC90 of 64 mg/L. Moreover the majority of inhibitory zone
sizes by the disc diffusion method (DIN 58940) corresponded to intermediate susceptibility.
These results suggest that fosfomycin at a high dosage and possibly used in combination with
other drugs could be a potentially useful drug for the treatment of infections caused by
vancomycin-resistant enterococci.
* Corresponding author. Tel: +43-512-583391; Fax: +43-512-574414; E-mail: franz.allerberger{at}uibk.ac.at
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