Methods: This retrospective chart review evaluated adults that received at least 1 dose of fosfomycin during the period 2014–2017. Information was collected using electronic medical records (e.g., demographics, symptoms, dose/duration of fosfomycin, urine culture results, length of stay, and hospital readmission). Statistical analysis was performed using descriptive statistics.
Results: 43 patients were included (60.5% females). Nearly half of the population (48.8%) had a history of recurrent UTIs. Patients received fosfomycin for cystitis (58.1%), pyelonephritis (34.9%), and asymptomatic bacteriuria (7%). Only 2 patients received greater than 1 dose. Empiric use of fosfomycin was seen in only 9.3%. Of those treated based on culture results, 84.6% of patients had MRDOs (29 ESBL, 2 VRE, 1 KPC, 1 resistant-Pseudomonas). No isolates had fosfomycin susceptibilities performed. In 72% of the time, patients had no other oral options. In 74.3% of the time, fosfomycin was used as step-down therapy from intravenous (IV) antibiotics (e.g., carbapenems 69%, ceftriaxone 13.8%). Infectious Diseases was consulted on 81.4% of cases. 7% of patients had documented allergies to the preferred agent. Treatment success was seen in 93% of patients, while 3 patients failed treatment requiring readmission for IV therapy. Fosfomycin use resulted in earlier discharge in 75.8% of cases (range of 1–6 days, mean 2.92 hospital days avoided per patient). For those who received fosfomycin as part of their emergency visit, 90% (9 of 10) were able to avoid hospitalization.
Conclusion: In our study, fosfomycin was used in UTI caused by MRDOs, with treatment successfully demonstrated in a majority of patients. Fosfomycin allowed for patients to avoid hospitalization or promoted earlier discharge, on average 3 days sooner than anticipated. Use of fosfomycin should be considered in appropriate patients in an effort to decrease length-of-stay or altogether avoid hospitalization.
T. L. Doan, None