Clinical isolates of
Enterobacterales
other than
Escherichia coli
(EOTEC), non-fermenting Gram-negative bacilli, and Gram-positive cocci were tested for susceptibility to fosfomycin using Etest
®
and reference agar dilution. Applying EUCAST (v. 11.0, 2021) intravenous fosfomycin breakpoints, Etest
®
MICs for EOTEC showed essential agreement (EA), categorical agreement (CA), major error (ME), and very major error (VME) rates of 70.4%, 88.4%, 4.1%, and 32.1%, respectively. No species of EOTEC tested with acceptable rates for all of EA (≥90%), CA (≥90%), ME (≤3%), and VME (≤3%). Etest
®
MICs for
Enterococcus faecalis
, interpreted using CLSI oral/urine criteria (M100, 2021), showed EA, CA, minor error, ME, and VME rates of 98.5%, 81.2%, 18.8%, 0%, and 0%. Against
Staphylococcus aureus
, EA, CA, and ME rates were 84.1%, 98.7%, and 1.3% (EUCAST intravenous criteria).
S. aureus
isolates with fosfomycin MICs >32 μg/ml (resistant) were not identified by agar dilution. We conclude performing fosfomycin Etest
®
on isolates of
S. aureus
will reliably identify fosfomycin-susceptible isolates with low, acceptable rates of MEs and VMEs. Testing of urinary isolates of
E. faecalis
by Etest
®
is associated with an unacceptably high rate of minor errors (18.8%) but low, acceptable rates of MEs and VMEs when results are interpreted using CLSI criteria. Isolates of EOTEC tested by Etest
®
with resulting MICs interpreted by EUCAST criteria were associated with an unacceptably high VME rate (32.1%).
In vitro
testing of clinical isolates beyond
E. coli
,
E. faecalis
, and
S. aureus
to determine susceptibility to fosfomycin is problematic with current methods and breakpoints.