759. Fosfomycin For The Treatment Of Multidrugresistant (MDR) Gram Negative Bacilli (GNB) and Extended Spectrum Beta Lactamase (ESBL) E Coli
Session: Poster Abstract Session: Antimicrobials: Treatment of HAI and Resistant Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • 759-IDWPOSTER.pdf (234.0 kB)
  • Background:

    Urinary tract infection (UTI) with GNB especially Escherichia coli (E Coli) is one of the most common encountered bacterial infections. These MDR organisms especially ESBL producing, can significantly limit antimicrobial option. Fosfomycin can be an effective therapy for these MDR pathogens.


    Initially, we tested 25 ESBL E Coli strains isolated from urine samples preceding the start of this project and found all of them sensitive to fosfomycin. Accordingly, patients with ESBL E coli UTI and other MDR organisms were treated with 3grams fosfomycin administered orally every other day for 10 to 14 days. Patients were educated on treatment options and side effects before initiation. Follow up was done till resolution of symptoms and negative urine cultures.


    Thirteen patients with UTI treated with fosfomycin from 4/2012 to 4/2013 were reviewed. Eleven cases had ESBL E coli, one MDR Proteus and one MDR Citrobacter. Patients age range from 51-88 yrs with a mean of 69.5yrs. Of these five were males and eight were females. The most common presenting complaint was dysuria (10/13), followed by fever (2/13) and low back pain (1/13). DM was present in 5/13 patients, urethral stricture (3/13), hypotonic bladder (1/13), urinary incontinence (1/13), and renal transplant (1/13). Both patients with the Proteus and Citrobacter isolates as well as 8 patients with ESBL E Coli were successfully treated with single course of oral fosfomycin for 10-14 days. Of the remaining 3 patients with ESBL E coli, one had recurrence after first course and resolved with a second course after failing parental ertapenem. One patient was treated with fosfomycin and ertapenem combined for 4 weeks who had initially failed with ertapenem alone. Only one patient did not tolerate fosfomycin secondary to nausea, vomiting and diarrhea and had to discontinue. Compared to intravenous Ertapenem, cost was reduced by 30% with no significant toxicity.


    Oral Fosfomycin was successfully used to treat patients with ESBL E coli UTI. Given easy route of administration and good tolerability, fosfomycin offers a good treatment option, cost effective, an alternative with better compliance compared to intravenous antimicrobial therapy. Further studies urgently needed to confirm its efficacy and safety.

    Muhammad Adnan Balouch, MD1, Rizma Jalees Bajwa, MD1 and Ali Hassoun, MD FACP2, (1)Huntsville Hospital, Huntsville, AL, (2)Alabama Infectious Diseases Center, Huntsville, AL


    M. A. Balouch, None

    R. J. Bajwa, None

    A. Hassoun, None

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