Antimicrob Agents Chemother. 2012 Aug 27. [Epub ahead of print]
Experience with Fosfomycin for the Treatment of Urinary Tract Infections due to Multi-DrugResistant Organisms.
Neuner EA, Sekeres J, Hall GS, van Duin D.
Department of Pharmacy, Cleveland Clinic, 9500 Euclid Ave/Hb105, Cleveland, OH 44195; Department of Pharmacy, Cleveland Clinic, Cleveland, OH; Department of Microbiology, Cleveland Clinic, Cleveland, OH; Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH.
Fosfomycin has shown promising in vitro activity against multi-drug resistant (MDR) urinary pathogens however clinical data is lacking. We conducted a retrospective chart review to describe the microbiological & clinical outcomes of urinary tract infections (UTIs) with MDR pathogens treated withfosfomycin tromethamine. Charts from 41 hospitalized patients with a urine culture for a MDR pathogen who received fosfomycin tromethamine from 2006 to 2010 were reviewed. 41 patients had 44 urinary pathogens including 13 carbapenem-resistant Klebsiella pneumoniae (CR-Kp), 8 Pseudomonas aeruginosa, 7 vancomycin-resistant Enterococcus faecium (VRE), 7 extended-spectrum beta-lactamase (ESBL) producers and 9 others. In vitro fosfomycin susceptibility was 86% (median MIC 16 μg/mL, range 0.25-1024 μg/mL). Patients received an average of 2.9 fosfomycindoses per treatment course. Overall microbiological cure was 59%, failure was due to either relapse (24%) or reinfection UTI (17%). Microbiological cure rates by pathogen were 46% CR-Kp, 38% P. aeruginosa, 71% VRE, 57% ESBL producers, and 100% others. Microbiological cure (n=24) was compared to microbiological failure (n=17). There were significantly more solid organ transplant recipients in the microbiological failure group (59% vs 21%, p=0.02). None of the patients in the microbiological cure group had a ureteral stent compared to 24% of patients within the microbiological failure group (p=0.02). Fosfomycin demonstrated in vitro activity against UTIs due to MDR pathogens. For CR-KP, there was a divergence between in vitro susceptibility (92%) and microbiological cure (46%). Multiple confounding factors may have contributed to microbiological failures and further data regarding the use of fosfomycin for UTIs due to MDR pathogens are needed.
[PubMed – as supplied by publisher]