Identification and characterisation of fosfomycin resistance in Escherichia coli urinary tract infection isolates from Australia

•Report of two fosfomycin-resistant Escherichia coli urinary tract infection isolates from Australia.•The fosA4 gene was identified in the two clinical E. coli isolates.•fosA4 was previously reported in the literature in only one clinical E. coli isolate in Japan in 2014.•Other antimicrobial resistance genes harboured by the fosfomycin-resistant E. coli isolates were identified. Of 1033 Escherichia coli urinary tract infection isolates collected from females >12 years of age in Australia in 2019, only 2 isolates were resistant to fosfomycin with a minimum inhibitory concentration (MIC) of >256 mg/L. Despite having different multilocus sequence types, the two isolates harboured an identical plasmid-encoded fosA4 gene. The fosA4 gene has previously been identified in a single clinical E. coli isolate cultured in Japan in 2014. Each fosfomycin-resistant isolate harboured two conjugative plasmids that possessed an array of genes conferring resistance to aminoglycosides, β-lactams, macrolides, quinolones, sulfonamides and/or trimethoprim.