Abstract
PurposeIn Europe, intravenous fosfomycin (IV) is used particularly in difficult-to-treat or complex infections, caused by both Gram-positive and Gram-negative pathogens including multidrug-resistant strains. Here, we investigated the efficacy and safety of intravenous fosfomycin under real-life conditions.MethodsProspective, multi-center, and non-interventional study in patients with bacterial infections from 20 intensive care units (ICU) in Germany and Austria (NCT01173575).ResultsOverall, 209 patients were included (77 females, 132 males, mean age: 59 ± 16 years), 194 of which were treated in intensive care (APACHE II score at the beginning of fosfomycin therapy: 23 ± 8). Main indications (± bacteremia or sepsis) were infections of the CNS (21.5%), community- (CAP) and hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP, 15.3%), bone and joint infections (BJI, 11%), abdominal infections (11%), and bacteremia (10.5%). Most frequently identified pathogens were S. aureus (22.3%), S. epidermidis (14.2%), Enterococcus spp. (10.8%), E. coli (12.3%) and Klebsiella spp. (7.7%). At least one multidrug-resistant (MDR) pathogen was isolated from 51 patients (24.4%). Fosfomycin was administered with an average daily dose of 13.7 ± 3.5 g over 12.4 ± 8.6 days, almost exclusively (99%) in combination with other antibiotics. The overall clinical success was favorable in 81.3% (148/182) of cases, and in 84.8% (39/46) of patients with ≥ 1 MDR pathogen. Noteworthy, 16.3% (34/209) of patients developed at least one, in the majority of cases non-serious, adverse drug reaction during fosfomycin therapy.ConclusionOur data suggest that IV fosfomycin is an effective and safe combination partner for the treatment of a broad spectrum of severe bacterial infections in critically ill patients.
Highlights
Fosfomycin is a bactericidal broad-spectrum antibiotic active against a variety of Gram-positive (GP) and Gramnegative (GN) pathogens including ‘problem bacteria’ such as carbapenemase- or extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci and multidrug-resistant (MDR) Pseudomonas aeruginosa [1,2,3,4,5], supported by synergistic effects withExtended author information available on the last page of the article many other antibiotics [6, 8]
All patients were treated in intensive care (92.8%), while 65.1% (n = 136) had pre-existing risk factors for bacterial infections such as diabetes mellitus, smoking, immunosuppression/corticosteroids, chronic renal insufficiency, liver cirrhosis and intensive antibiotic pretreatment within the last month
We found a broad use of intravenous fosfomycin (IV) fosfomycin against both GP and GN pathogens with a higher proportion of Gram-positives (54.2%)
Summary
Fosfomycin is a bactericidal broad-spectrum antibiotic active against a variety of Gram-positive (GP) and Gramnegative (GN) pathogens including ‘problem bacteria’ such as carbapenemase- or extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci and multidrug-resistant (MDR) Pseudomonas aeruginosa [1,2,3,4,5], supported by synergistic effects withExtended author information available on the last page of the article many other antibiotics [6, 8]. Fosfomycin is a bactericidal broad-spectrum antibiotic active against a variety of Gram-positive (GP) and Gramnegative (GN) pathogens including ‘problem bacteria’ such as carbapenemase- or extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci and multidrug-resistant (MDR) Pseudomonas aeruginosa [1,2,3,4,5], supported by synergistic effects with. Fosfomycin can be used without any age limitations. Due to the high sodium load (1 g fosfomycin contains 14 mmol (320 mg) sodium), electrolyte imbalances such as hypernatremia or hypokalemia might occur [6, 15]. Fosfomycin was included in the WHO list of essential medicines for treatment of adults and children within the RESERVE group of antibacterial medicines [16, 17]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
