1827. Intravenous Fosfomycin Therapy in Critically Ill Patients Infected with Colistin Resistant Enterobacteriacae
Session: Poster Abstract Session: Treatment of HAIs/Antimicrobial Resistant Infections
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDSA 2015 P-1827.pdf (188.1 kB)
  • Background: Carbapenem resistant enterobacteriacae (CRE) emerged in recent years as one of the most challenging group of antibiotic resistant pathogens. Polymyxins are considered as the last resort for the treatment of infections with carbapenem resistant gram negative bacilli (GNB). Inadequate or extensive use of colistin leads to emergence of colistin resistance, increasing mortality and morbidity and necessitating prudent use of alternative antibiotics. Fosfomycin, a phosponic acid derivative which acts by disrupting bacterial cell wall synthesis, is a broad spectrum antibiotic. It is available as sodium/disodium formulation for intravenous use and is showing promising result against multi drug resistant(MDR) /Pan Drug Resistant (PDR) pathogens.

    Methods:

    A total of four colistin resistant (MIC>=4) GNB were isolated from ICU patients with nosocomial MDR infections. All four isolates were Klebsiella pneumonia. Among these isolates three were from blood and one from endotracheal aspirate. All four isolates were sensitive to fosfomycin in vitro. All of these patients had multiple co-morbidities with recent history of colistin exposure. Intravenous fosfomycin was given as a combination therapy with carbapenem.

    Results:

    Among the three bacterimic patients, two recovered completely from sepsis. The only one bacterimic patient who died during the course of therapy was later on diagnosed to have azole resistant fungemia as super infection. The patient with ventilator associated pneumonia also responded well after initiation of fosfomycin therapy. Successful ventilator weaning was possible as well as clinical cure. Average duration of antibiotic therapy in all these cases was ten days.

    Conclusion:

    Based on the evidence of clinical experience and available studies, intravenous fosfomycin therapy may be considered as the last option for the treatment of MDR GNB infection where there is documented colistin resistance and where there is literally no other choice of antibiotic therapy. The success of the therapy is encouraging in selected group of patients. Further research on intravenous fosfomycin use specially against MDR pathogens and on the effectiveness and safety of the drug in the treatment of patients with such infections may be warranted.

    Dip Narayan Mukherjee, MD, Clinical Microbiology Dept, Woodlands Multispeciality Hospital, Kolkata,, India, Lalit Agarwal, DM, Dept of Nephrology, Woodlands Multispeciality Hospital, Kolkata, India and Kaushik Mandal, MBBS, Calcutta Medical College, Kolkata, India

    Disclosures:

    D. N. Mukherjee, None

    L. Agarwal, None

    K. Mandal, None

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