Urinary tract infections (UTI) are the most common infection associated with multidrug-resistant (MDR) pathogens. With limited treatment options, there has been an increasing interest in the efficacy of fosfomycin (FOS); however, real-world clinical data are limited. Our objective was to assess the outcomes of hospitalized patients with MDR UTIs treated with FOS.
Retrospective review of patients with carbapenem resistant (CRE) or extended spectrum β-Lactamase producing (ESBL) Enterobacteriaceae, or vancomycin resistant Enterococcus (VRE) UTIs who received ≥1 dose of FOS. UTI was defined as a urine culture with ≥1000 CFU/ml among patients (pts) with dysuria, increased urinary frequency, suprapubic or flank pain or tenderness, fevers, or altered mental status without an alternative etiology. We defined cure as resolution of symptoms within 7 days without reoccurrence within 30 days. Microbiological failure was defined as a positive urine culture within 14 days.
49 pts with MDR UTIs (17 ESBL, 17 VRE, 15 CRE) were included. Median age was 69 (range: 20 – 95), 18% were male, 14% were immunosuppressed and the median Charlson score was 4 (0 – 12). 33% had indwelling catheters and 10% of pts had neurogenic bladder. Increased frequency (29%) and fever (27%) were the most common symptoms. 51% of cases were healthcare associated and 64% met the CDC/NHSN definition of UTI. UTIs were complicated by pyelonephritis in 2 pts, but none had concomitant bacteremia. FOS was administered as empiric or definitive treatment in 39% and 61%, respectively. Only 12% of pts received >1 dose. Cure occurred in 88% of pts, and did not vary by infecting pathogen (Figure 1, Table 2), or the number of FOS doses received. Pts with relapsing symptoms were infected by ESBL (n=3), CRE (n=1), and VRE (n=3); all but one received 1 dose of FOS. Microbiologic failures occurred in 18% due to ESBL (n=1), CRE (n=4), and VRE (n=4). 4% of pts died in-hospital, but only 1 death was related to UTI. Overall, FOS was well-tolerated with vomiting recorded in one pt.
Across a range of MDR pathogens causing UTIs, FOS was well-tolerated and effective for hospitalized pts. FOS represents an attractive oral option to preserve alternative agents for systemic infections. Future studies are needed to evaluate the benefit of repeated dosing.
R. K. Shields, None