Abstract
Fosfomycin is an oral antibiotic with activity against multidrug resistant organisms, including vancomycin-resistant enterococcus (VRE) and extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae. However, there is currently no information describing effiacy of fosfomycin compared to other agents for healthcare associated UTIs. Additionally, there is minimal information characterizing the potential cost savings with utilization of fosfomcyin versus traditional therapies. This retrospective study evaluated clinical and economic outcomes of fosfomycin compared to matched controls. The controls were before the addition of fosfomycin to hospital formulary with recommended prescribing criteria. The fosfomycin group consisted of patients who were admitted to the hospital after the addition of fosfomycin to the hospital formulary with recommended prescribing criteria. Patients receiving fosfomycin for the treatment of UTI were matched to control patients based on pathogen, renal function, and presence of a lower UTI. A total of 86 patients were evaluated. The majority of patients received fosfomycin for the treatment of VRE (45.6%) and ESBL producing Enterbacteriaceae (16.3%) UTIs. Patients with a combination of allergies or documented resistance to fist line agents also received fosfomycin to treat Enterococcus (25.6%), Enterobacteriaceae (7.8%), or polymicrobial UTIs (4.7%). Doxycycline, nitrofurantoin, sulfamethoxazole/trimethoprim, meropenem, and linezolid were the most common antibiotics prescribed in the control group. The average days of treatment were lower in the fosfomycin group (2.93 vs. 7.19 days, p 0.99) and recurrence rates (4.7 vs. 4.7%, p>0.99). Additionally , the mean antibiotic cost per patient was lower in the fosfomycin group ($106.74 vs. $269.55). Adding fosfomycin to formulary resulted in similar clinical success rates and lower cost for the treatment of complicated lower and uncomplicated UTIs.
Highlights
Multi-drug resistant (MDR) urinary tract infections (UTI) caused by extended spectrum β-lactamase (ESBL) producing Enterobacteriaceae and vancomycin-resistant Enterococci (VRE) have become more prevalent. [1,2,3] Due to high resistance rates to oral antibiotics, VRE and ESBL UTIs are commonly treated with intravenous antibiotics which are more expensive and inconvenient for patients. [2, 4] there is a need for less expensive and effective alternative antibiotics for the treatment of VRE and ESBL UTIs. [5,6,7,8,9] Fosfomycin tromethamine is a synthetic, broad spectrum, bactericidal antibiotic that works by inhibiting pyruvyl transferase during bacterial cell wall synthesis, and it may decreases bacterial adherence to epithelial cells in the urinary tract
[11] Fosfomycin has demonstrated efficacy in both in vitro and in vivo studies for treating UTIs caused by ESBL-producing Enterobacteriaceae, [12,13,14,15] while in vitro studies have shown high susceptibility of VRE to fosfomycin with susceptibilities of 98%. [5,6,7] Clinical data are limited to bolster the use of fosfomycin; a recent study showed high microbiological cure rates and in vitro susceptibility of VRE and ESBL UTI isolates to fosfomycin
[16] In 2010, the University of Michigan Health System (UMHS) Antimicrobial Stewardship Program introduced a guideline recommending the use of fosfomycin tromethamine for the treatment of lower UTIs caused by VRE or ESBL producing organisms that are resistant to other oral antibiotics
Summary
[1,2,3] Due to high resistance rates to oral antibiotics, VRE and ESBL UTIs are commonly treated with intravenous antibiotics which are more expensive and inconvenient for patients. [11] Fosfomycin has demonstrated efficacy in both in vitro and in vivo studies for treating UTIs caused by ESBL-producing Enterobacteriaceae, [12,13,14,15] while in vitro studies have shown high susceptibility of VRE to fosfomycin with susceptibilities of 98%. [16] In 2010, the University of Michigan Health System (UMHS) Antimicrobial Stewardship Program introduced a guideline recommending the use of fosfomycin tromethamine for the treatment of lower UTIs caused by VRE or ESBL producing organisms that are resistant to other oral antibiotics
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