Document Detail


Experience with fosfomycin for treatment of urinary tract infections due to multidrug-resistant organisms.
MedLine Citation:
PMID:  22926565     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Elizabeth A Neuner; Jennifer Sekeres; Gerri S Hall; David van Duin
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Publication Detail:
Type:  Journal Article     Date:  2012-08-27
Journal Detail:
Title:  Antimicrobial agents and chemotherapy     Volume:  56     ISSN:  1098-6596     ISO Abbreviation:  Antimicrob. Agents Chemother.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-17     Completed Date:  2013-04-23     Revised Date:  2013-07-12    
Medline Journal Info:
Nlm Unique ID:  0315061     Medline TA:  Antimicrob Agents Chemother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  5744-8     Citation Subset:  IM    
Affiliation:
Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio, USA. neunere@ccf.org
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MeSH Terms
Descriptor/Qualifier:
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:
0/Anti-Bacterial Agents; 0/Carbapenems; 23155-02-4/Fosfomycin; EC 3.5.2.6/beta-Lactamases
Comments/Corrections

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