Emerging Concepts for the Treatment of Biofilm-Associated Bone and Joint Infections with IV Fosfomycin: A Literature Review
Due to the involvement of biofilms in the pathogenesis of bone and joint infections (BJI), the treatment of these infections is often challenging, especially when multidrug- or extensively drug-resistant (MDR/XDR) pathogens are involved. Intravenous fosfomycin (FOS) is a phosphoenolpyruvate analogue...
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2025-04-01
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| author | Sara Tedeschi Efthymia Giannitsioti Christian Mayer |
| author_facet | Sara Tedeschi Efthymia Giannitsioti Christian Mayer |
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| description | Due to the involvement of biofilms in the pathogenesis of bone and joint infections (BJI), the treatment of these infections is often challenging, especially when multidrug- or extensively drug-resistant (MDR/XDR) pathogens are involved. Intravenous fosfomycin (FOS) is a phosphoenolpyruvate analogue with a unique mode of action and broad-spectrum activity against both Gram-positive (GP) and Gram-negative (GN) pathogens. It is used in various severe and deep-seated infections, including BJIs. This review article focuses on preclinical and clinical data surrounding the use of FOS for biofilm-related BJIs. Data from several in vitro and animal models of infection demonstrated that FOS, especially in combination with other antibiotics, is effective against biofilms of (methicillin-resistant) <i>Staphylococcus</i> spp., (vancomycin-resistant) <i>Enterococcus</i> spp., carbapenem-resistant and extended-spectrum beta-lactamase-producing Enterobacterales, and MDR <i>Pseudomonas aeruginosa</i>. Data from clinical studies, mostly retrospective observational studies and case reports/case series, revealed that FOS was typically used in combination with other antibiotics for the treatment of various BJI, including acute and chronic osteomyelitis, prosthetic joint infections, and fracture-related infections, in adult and pediatric patients. Success rates often exceeded 80%. FOS exhibits good and fast penetration into bone tissue and is generally well tolerated, with only a few adverse drug reactions, such as gastrointestinal disorders and electrolyte imbalances. Collectively, the data indicate that FOS is a valuable option as part of combination regimens for the treatment of BJIs caused by both GP and GN bacteria. |
| format | Article |
| id | doaj-art-8768c4721fa5400a85fb8929ce36f8d3 |
| institution | DOAJ |
| issn | 2076-2607 |
| language | English |
| publishDate | 2025-04-01 |
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| spelling | doaj-art-8768c4721fa5400a85fb8929ce36f8d32025-08-20T03:14:46ZengMDPI AGMicroorganisms2076-26072025-04-0113596310.3390/microorganisms13050963Emerging Concepts for the Treatment of Biofilm-Associated Bone and Joint Infections with IV Fosfomycin: A Literature ReviewSara Tedeschi0Efthymia Giannitsioti1Christian Mayer2Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy1st Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, GreeceInfectoPharm Arzneimittel und Consilium GmbH, 64646 Heppenheim, GermanyDue to the involvement of biofilms in the pathogenesis of bone and joint infections (BJI), the treatment of these infections is often challenging, especially when multidrug- or extensively drug-resistant (MDR/XDR) pathogens are involved. Intravenous fosfomycin (FOS) is a phosphoenolpyruvate analogue with a unique mode of action and broad-spectrum activity against both Gram-positive (GP) and Gram-negative (GN) pathogens. It is used in various severe and deep-seated infections, including BJIs. This review article focuses on preclinical and clinical data surrounding the use of FOS for biofilm-related BJIs. Data from several in vitro and animal models of infection demonstrated that FOS, especially in combination with other antibiotics, is effective against biofilms of (methicillin-resistant) <i>Staphylococcus</i> spp., (vancomycin-resistant) <i>Enterococcus</i> spp., carbapenem-resistant and extended-spectrum beta-lactamase-producing Enterobacterales, and MDR <i>Pseudomonas aeruginosa</i>. Data from clinical studies, mostly retrospective observational studies and case reports/case series, revealed that FOS was typically used in combination with other antibiotics for the treatment of various BJI, including acute and chronic osteomyelitis, prosthetic joint infections, and fracture-related infections, in adult and pediatric patients. Success rates often exceeded 80%. FOS exhibits good and fast penetration into bone tissue and is generally well tolerated, with only a few adverse drug reactions, such as gastrointestinal disorders and electrolyte imbalances. Collectively, the data indicate that FOS is a valuable option as part of combination regimens for the treatment of BJIs caused by both GP and GN bacteria.https://www.mdpi.com/2076-2607/13/5/963bone and joint infectionfosfomycinmultidrug-resistantcarbapenem-resistant<i>Staphylococcus aureus</i><i>Klebsiella pneumoniae</i> |
| spellingShingle | Sara Tedeschi Efthymia Giannitsioti Christian Mayer Emerging Concepts for the Treatment of Biofilm-Associated Bone and Joint Infections with IV Fosfomycin: A Literature Review Microorganisms bone and joint infection fosfomycin multidrug-resistant carbapenem-resistant <i>Staphylococcus aureus</i> <i>Klebsiella pneumoniae</i> |
| title | Emerging Concepts for the Treatment of Biofilm-Associated Bone and Joint Infections with IV Fosfomycin: A Literature Review |
| title_full | Emerging Concepts for the Treatment of Biofilm-Associated Bone and Joint Infections with IV Fosfomycin: A Literature Review |
| title_fullStr | Emerging Concepts for the Treatment of Biofilm-Associated Bone and Joint Infections with IV Fosfomycin: A Literature Review |
| title_full_unstemmed | Emerging Concepts for the Treatment of Biofilm-Associated Bone and Joint Infections with IV Fosfomycin: A Literature Review |
| title_short | Emerging Concepts for the Treatment of Biofilm-Associated Bone and Joint Infections with IV Fosfomycin: A Literature Review |
| title_sort | emerging concepts for the treatment of biofilm associated bone and joint infections with iv fosfomycin a literature review |
| topic | bone and joint infection fosfomycin multidrug-resistant carbapenem-resistant <i>Staphylococcus aureus</i> <i>Klebsiella pneumoniae</i> |
| url | https://www.mdpi.com/2076-2607/13/5/963 |
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