| Experience with fosfomycin for treatment of urinary tract infections due to multidrug-resistant organisms. | |
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MedLine Citation:
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PMID: 22926565 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Fosfomycin has shown promising in vitro activity against multidrug-resistant (MDR) urinary pathogens; however, clinical data are lacking. We conducted a retrospective chart review to describe the microbiological and clinical outcomes of urinary tract infections (UTIs) with MDR pathogens treated with fosfomycin tromethamine. Charts for 41 hospitalized patients with a urine culture for an MDR pathogen who received fosfomycin tromethamine from 2006 to 2010 were reviewed. Forty-one patients had 44 urinary pathogens, including 13 carbapenem-resistant Klebsiella pneumoniae (CR-Kp), 8 Pseudomonas aeruginosa, and 7 vancomycin-resistant Enterococcus faecium (VRE) isolates, 7 extended-spectrum beta-lactamase (ESBL) producers, and 9 others. In vitro fosfomycin susceptibility was 86% (median MIC, 16 μg/ml; range, 0.25 to 1,024 μg/ml). Patients received an average of 2.9 fosfomycin doses per treatment course. The overall microbiological cure was 59%; failure was due to either relapse (24%) or reinfection UTI (17%). Microbiological cure rates by pathogen were 46% for CR-Kp, 38% for P. aeruginosa, 71% for VRE, 57% for ESBL producers, and 100% for 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% versus 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. |
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Authors:
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Elizabeth A Neuner; Jennifer Sekeres; Gerri S Hall; David van Duin |
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Publication Detail:
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Type: Journal Article Date: 2012-08-27 |
Journal Detail:
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Title: Antimicrobial agents and chemotherapy Volume: 56 ISSN: 1098-6596 ISO Abbreviation: Antimicrob. Agents Chemother. Publication Date: 2012 Nov |
Date Detail:
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Created Date: 2012-10-17 Completed Date: 2013-04-23 Revised Date: 2013-05-02 |
Medline Journal Info:
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Nlm Unique ID: 0315061 Medline TA: Antimicrob Agents Chemother Country: United States |
Other Details:
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Languages: eng Pagination: 5744-8 Citation Subset: IM |
Affiliation:
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Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio, USA. neunere@ccf.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anti-Bacterial Agents / pharmacology, therapeutic use* Carbapenems / pharmacology, therapeutic use Drug Resistance, Multiple, Bacterial* Enterococcus faecium / drug effects*, growth & development Female Fosfomycin / pharmacology, therapeutic use* Humans Klebsiella pneumoniae / drug effects*, growth & development Male Microbial Sensitivity Tests Middle Aged Pseudomonas aeruginosa / drug effects*, growth & development Retrospective Studies Treatment Outcome Urinary Tract Infections / drug therapy*, microbiology beta-Lactamases / metabolism |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents; 0/Carbapenems; 23155-02-4/Fosfomycin; EC 3.5.2.6/beta-Lactamases |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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