Clinical Appraisal of Fosfomycin in the Era of Antimicrobial Resistance.
Antimicrob Agents Chemother. 2015 Sep 14;
Authors: Sastry S, Clarke LG, Al-Rowais H, Querry AM, Shutt KA, Doi Y
Abstract
Fosfomycin is recommended as one of the first-line agents for treatment of urinary tract infection (UTI) in the latest guideline endorsed by the IDSA and the ESCMID. We evaluated the use of fosfomycin among inpatients at a tertiary hospital between 2009 and 2013. UTI cases were defined using physician diagnosis and the National Healthcare Safety Network (NHSN) surveillance definitions. The number of patients treated with fosfomycin increased from none in 2009 to 391 in 2013. Of 537 patients who received fosfomycin for any indication during this period, UTI was the most common indication (74%), followed by asymptomatic bacteriuria (10%). All except 19 patients received a single dose of fosfomycin. Escherichia coli was the most common organism involved (52%). For 119 patients with UTI after excluding those with negative urine culture, negative urinalysis, receipt of additional agents or indeterminate clinical outcome, the clinical success rate at 48 hours was 74.8%. Of 89 patients who met the criteria for NHSN-defined UTI, 89.9% had successful outcome. Recurrent infection occurred in 4.3%, and mild adverse events were observed in 2.0%. All 100 extended-spectrum β-lactamase (ESBL)-producing E. coli clinical isolates randomly selected from this period were susceptible to fosfomycin. In conclusion, use of fosfomycin has increased substantially since the implementation of the updated guidelines at this hospital. Fosfomycin was used mainly for the treatment of physician-diagnosed UTI and the clinical outcomes were generally favorable. Fosfomycin maintained activity against E. coli despite the increased use of the agent.
PMID: 26369978 [PubMed - as supplied by publisher]