c84a7dac23423ad930dcc1e5ed79aaa7 303480.pdf 91fedd6a33f2ea6995edc3b54665011d1e60bf78 303480.pdf 975112b3ab2f5771136132d309f556775a8b9b1a9ac0a5bfae93d3f1ef16f212 303480.pdf Creator: Servigistics Arbortext Advanced Print Publisher 11.1.4546/W-x64 Producer: PDFlib+PDI 9.0.7p3 (C++/Win64) CreationDate: Thu Jan 4 13:24:44 2024 CET ModDate: Thu Jan 4 13:24:44 2024 CET Custom Metadata: yes Metadata Stream: yes Tagged: yes UserProperties: no Suspects: no Form: none JavaScript: no Pages: 9 Encrypted: no Page size: 612.283 x 790.866 pts Page rot: 0 File size: 319100 bytes Optimized: yes PDF version: 1.6 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- SXDWFZ+FSMe-Bold Type 1C Custom yes yes yes 1070 0 MSSFXT+FSMe-BoldItalic Type 1C Custom yes yes yes 1075 0 ZEMIIS+FSMe-LightItalic Type 1C Custom yes yes yes 1080 0 LPTUVT+FSMe-Light Type 1C Custom yes yes yes 1085 0 TCLTVK+FSMe Type 1C Custom yes yes yes 1090 0 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Flags: Nonsymbolic FontBBox: -568, -307, 2046, 1040 FontFile2: true XMP: uuid:CBB0384B-6ECA-E981-B2BA-B7B061513BA3 uuid:9DA28EA4-8CCC-CB4E-6C2A-833D807FC722 True application/pdf 10.1093/jac/dkad147 en Oxford University Press Effectiveness of fosfomycin trometamol as oral step-down therapy for bacteraemic urinary tract infections due to MDR Escherichia coli: a post hoc analysis of the FOREST randomized trial Jesús Sojo-Dorado Inmaculada López-Hernández Alicia Hernández-Torres Pilar Retamar-Gentil Esperanza Merino de Lucas Laura Escolà-Vergé Elena Bereciartua Elisa García-Vázquez Vicente Pintado Lucía Boix-Palop Clara Natera-Kindelán Luisa Sorlí Nuria Borrell Concha Amador-Prous Evelyn Shaw Alfredo Jover-Saenz Jose Molina Rosa M. Martínez-Álvarez Carlos J. Dueñas Jorge Calvo-Montes María Lecuona Virginia Pomar Irene Borreguero Virginia Palomo-Jiménez Fernando Docobo-Pérez Álvaro Pascual Jesús Rodríguez-Baño DOI: 10.1093/jac/dkad147; Journal of Antimicrobial Chemotherapy, 78, 7, 2023-06-1.; Abstract: Background: Fosfomycin is a potentially attractive option as step-down therapy for bacteraemic urinary tract infections (BUTI), but available data are scarce. Our objective was to compare the effectiveness and safety of fosfomycin trometamol and other oral drugs as step-down therapy in patients with BUTI due to MDR Escherichia coli (MDR-Ec). Methods: Participants in the FOREST trial (comparing IV fosfomycin with ceftriaxone or meropenem for BUTI caused by MDR-Ec in 22 Spanish hospitals from June 2014 to December 2018) who were stepped-down to oral fosfomycin (3 g q48h) or other drugs were included. The primary endpoint was clinical and microbiological cure (CMC) 5–7 days after finalization of treatment. A multivariate analysis was performed using logistic regression to estimate the association of oral step-down with fosfomycin with CMC adjusted for confounders. Results: Overall, 61 patients switched to oral fosfomycin trometamol and 47 to other drugs (cefuroxime axetil, 28; amoxicillin/clavulanic acid and trimethoprim/sulfamethoxazole, 7 each; ciprofloxacin, 5) were included. CMC was reached by 48/61 patients (78.7%) treated with fosfomycin trometamol and 38/47 (80.9%) with other drugs (difference, −2.2; 95% CI: −17.5 to 13.1; P = 0.38). Subgroup analyses provided similar results. Relapses occurred in 9/61 (15.0%) and 2/47 (4.3%) of patients, respectively (P = 0.03). The adjusted OR for CMC was 1.11 (95% CI: 0.42–3.29, P = 0.75). No relevant differences in adverse events were seen. Conclusions: Fosfomycin trometamol might be a reasonable option as step-down therapy in patients with BUTI due to MDR-Ec but the higher rate of relapses would need further assessment. © The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. PDFlib+PDI 9.0.7p3 (C++/Win64) Journal Journal of Antimicrobial Chemotherapy © The Author(s) 2023. 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