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.
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.
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.
D. N. Mukherjee,
K. Mandal, None
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