Abstract
Background: Antimicrobial drugs to treat male urinary tract infection (UTI) with multidrug-resistant Enterobacterales are limited. We studied oral fosfomycin-trometamol (FT) in this situation. The objective was to assess the clinical cure rate in patients presenting UTIs treated with oral FT. Methods: We conducted a single-center observational retrospective study from January 2017 to August 2018. The primary endpoint was clinical cure; and the secondary endpoints were incidence of recurrences, oral FT safety, and microbiological cure. Results: Sixteen male patients were included, presenting 21 UTI episodes. Fourteen patients (88%) have at least one underlying urologic disorder. We described 4 episodes of acute UTI and 17 episodes of chronic bacterial prostatitis (CBP). Sixteen out of twenty-one Enterobacterales were extended spectrum beta-lactamase (ESBL)-producers and all the patients presented a resistance to fluoroquinolones and trimethoprim/sulfamethoxazole. In acute UTI, the regimen was a daily dose of oral FT for a mean duration of 2.5 weeks (+/−7.0 days). Clinical and microbiological recovery was achieved in all patients, with no recurrence after 5.3 months follow-up on average (+/−10.4 days). In CBP, the regimen was one oral dose of fosfomycin every 24–48 h, for a mean duration of 5.5 weeks/UTI episodes (+/−15.3 days). Clinical and microbiological recovery was found in 16/17 cases. Seven of the twelve patients with CBP had relapsed and 3/12 had had a new episode of infection after an average follow-up of 5.8 months. Only 6/21 of patients presented minor or moderate adverse effects, such as digestive disorders. Conclusions: FT could be an alternative option to carbapenems in the treatment of multidrug-resistant Enterobacterales infections for male UTIs.
Highlights
The prevalence of male urinary tract infections (UTIs) is estimated to be between1.5 and 9% in the general population [1,2]
The therapeutic choice is limited and often concerns carbapenems, which remain the gold standard for most extended spectrum beta-lactamase (ESBL)-E infections—the consumption of which is increasing worrying worldwide [7]
We included all patients with a documented male Enterobacterales UTI susceptible to FT and treated with oral FT—used alone without combination with other active antimicrobials drugs
Summary
The prevalence of male urinary tract infections (UTIs) is estimated to be between1.5 and 9% in the general population [1,2]. The incidence of infections caused by extended-spectrum B-lactamase producing Enterobacterales (ESBL-E) has increased dramatically in French hospitals and Escherichia coli strains are the most prevalent species among ESBL-E [3]. This resistance is often accompanied by co-resistance to fluoroquinolones (FQ) and trimethoprim/sulfamethoxazole (SMX-TMP) [4,5,6]. Sixteen out of twenty-one Enterobacterales were extended spectrum beta-lactamase (ESBL)-producers and all the patients presented a resistance to fluoroquinolones and trimethoprim/sulfamethoxazole. In CBP, the regimen was one oral dose of fosfomycin every 24–48 h, for a mean duration of 5.5 weeks/UTI episodes (+/−15.3 days).
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