2412. Our Experience With IV Fosfomycin

Abstract

BackgroundAntimicrobial resistance in Gram-negative organism is a global problem. There is an increased interest in Fosfomycin due to its attractive PK/PD properties. The present study aimed to examine the effectiveness and safety of IV Fosfomycin which has been recently licensed in India.MethodsWe retrospectively studied patients who received IV Fosfomycin from January 2017 to February 2018. Patients with proven or suspected sepsis given IV Fosfomycin were included in the study. Clinical, microbiological outcome, and adverse reactions were noted.Results27 patients received IV fosfomycin. Of these 6 were excluded from the study because 2 had SIRS due to non-infective etiology, 1 had an organism with Fosfomycin resistance and 3 had incomplete clinical records. 7 patients received empirical and 14 received directed treatment. The most frequent isolate was carbapenem-resistant Klebsiella pneumoniae found in 8 patients. 1 patient received monotherapy while 20 received combination therapy. 9 patients were clinically cured. 1 showed clinical improvement, 8 worsened on treatment due to adverse drug reactions and 3 patients died while on treatment. Microbiological cure was seen in 6 patients. 3 had persistently positive cultures. 1 patient with bacteremic UTI due to Klebsiella pneumoniae received IV fosfomycin for 14 days and relapsed after 1 week of stopping treatment with the same organism showing fosfomycin resistance. 16 patients developed adverse drug reactions. The most common adverse drug reaction was diarrhea in 13, among them 1 had C. difficile colitis. Other adverse reactions like hypernatremia and hypokalemia were observed in 7 and 10 patients, respectively. Electrolyte imbalance were seen in patients aged >50 and those who received a higher dose than was appropriate for the creatinine clearance. 2 patients developed noncardiogenic pulmonary edema within 72 hours of starting fosfomycin and 1 developed torsades de pointes with QT prolongation due to hypokalemia ConclusionFosfomycin appears to be a useful addition to the treatment armamentarium. Although adverse events have not been considered significant in most reviews, they are highly significant in our experience. We recommend careful monitoring of fluid and electrolyte balance in patients receiving IV fosfomycinDisclosures All authors: No reported disclosures.