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
Sojo-Dorado, Jesús (Instituto de Salud Carlos III)
López-Hernández, Inmaculada (Instituto de Salud Carlos III)
Hernández-Torres, Alicia (Hospital Clínico Universitario Virgen de la Arrixaca (El Palmar, Múrcia))
Retamar-Gentil, Pilar (Instituto de Salud Carlos III)
Merino De Lucas, Esperanza (Universidad Miguel Hernández de Elche)
Escolà-Vergé, Laura (Hospital Universitari Vall d'Hebron)
Bereciartua, Elena (Hospital Universitario de Cruces (Barakaldo, País Basc))
García-Vázquez, Elisa (Hospital Clínico Universitario Virgen de la Arrixaca (El Palmar, Múrcia))
Pintado, Vicente (Hospital Universitario Ramón y Cajal (Madrid))
Boix-Palop, Lucía (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Natera-Kindelán, Clara (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Sorlí, Luisa (Hospital del Mar (Barcelona, Catalunya))
Borrell, Nuria (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Amador-Prous, Concha (Hospital Marina Baixa (La Vila Joiosa, Alacant))
Shaw, Evelyn (Hospital Universitari de Bellvitge)
Jover-Saenz, Alfredo (Institut de Recerca Biomèdica de Lleida)
Molina, Jose (Universidad de Sevilla)
Martínez-Álvarez, Rosa M. (Hospital Royo Villanova)
Dueñas, Carlos J. (Hospital Universitario de Burgos)
Calvo-Montes, Jorge (Hospital Universitario Marques de Valdecilla - IDIVAL)
Lecuona, María (Hospital Universitario de Canarias (La Laguna))
Pomar, Virginia (Institut d'Investigació Biomèdica Sant Pau)
Borreguero, Irene (Hospitales Universitarios Virgen del Rocío y Virgen Macarena)
Palomo-Jimenez, Virginia (Universidad de Sevilla)
Docobo-Perez, Fernando (Universidad de Sevilla)
Pascual Hernández, Álvaro (Instituto de Salud Carlos III)
Rodríguez-Baño, Jesús (Instituto de Salud Carlos III)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	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). 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. 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. 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.
Ajuts:	Ministerio de Economía y Competitividad PI13/01282
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Anti-Bacterial Agents ; Escherichia coli ; Escherichia coli Infections ; Fosfomycin ; Humans ; Recurrence ; Tromethamine ; Urinary Tract Infections
Publicat a:	Journal of antimicrobial chemotherapy, Vol. 78 Núm. 7 (january 2023) , p. 1658-1666, ISSN 1460-2091

DOI: 10.1093/jac/dkad147
PMID: 37260299

9 p, 311.6 KB

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