Efficacy of high doses of intravenous fosfomycin for treatment of urinary tract infection caused by KPC carbapenemase-producing Klebsiella pneumoniae: An observational study
ABSTRACT: Objective: To evaluate the efficacy of high-dose intravenous fosfomycin for the treatment of urinary tract infections (UTI) caused by KPC carbapenemase-producing Klebsiella pneumoniae (KPC-Kp). A secondary objective was to evaluate the impact of the results of fosfomycin susceptibility te...
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Elsevier
2025-03-01
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| Series: | Journal of Global Antimicrobial Resistance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716524004764 |
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| author | Jorge Rodríguez-Gómez Irene Gracia-Ahufinger I Rosario Carmona-Flores Julia Guzmán-Puche Rafael León Elena Pérez-Nadales Monserrat Muñoz de la Rosa Alejandra Mendez Natera Juan José Castón Ángela Cano Juan Jesús Pineda-Capitán Cristina López Carmen De la Fuente-Martos Julián Torre-Cisneros Luis Martínez-Martínez |
| author_facet | Jorge Rodríguez-Gómez Irene Gracia-Ahufinger I Rosario Carmona-Flores Julia Guzmán-Puche Rafael León Elena Pérez-Nadales Monserrat Muñoz de la Rosa Alejandra Mendez Natera Juan José Castón Ángela Cano Juan Jesús Pineda-Capitán Cristina López Carmen De la Fuente-Martos Julián Torre-Cisneros Luis Martínez-Martínez |
| author_sort | Jorge Rodríguez-Gómez |
| collection | DOAJ |
| description | ABSTRACT: Objective: To evaluate the efficacy of high-dose intravenous fosfomycin for the treatment of urinary tract infections (UTI) caused by KPC carbapenemase-producing Klebsiella pneumoniae (KPC-Kp). A secondary objective was to evaluate the impact of the results of fosfomycin susceptibility testing on prognosis. Methods: This is an observational and retrospective study. Patients hospitalized with UTI caused by KPC-Kp receiving treatment with high-dose intravenous fosfomycin were evaluated from December 2012 to June 2018. The primary outcome variable was clinical cure at d 21. Results: Forty-seven patients were included. The results of commercial microdilution panels showed that KPC-Kp isolates from 14 (29.8%) and 33 (70.2%) patients were non-susceptible and susceptible to fosfomycin, respectively. In 28 available isolates, susceptibility was also determined by the reference agar dilution method. In the global cohort, clinical cure was achieved at d 21 for 33 (70.2%) out of the 47 patients, with no statistical differences found between fosfomycin non-susceptible isolates and fosfomycin susceptible isolates as determined by commercial microdilution (78.6 vs. 66.7%; P = 0.50) or by the reference agar dilution (83.3 vs. 72.7%; P = 1). In the logistic regression analysis, the Pitt index was the only variable related to clinical cure at 21 d. No statistically significant differences were found for the variables associated with fosfomycin susceptibility testing or fosfomycin minimum inhibitory concentration. Conclusions: High-dose intravenous fosfomycin can be considered for treatment of hospitalized patients with KPC-Kp UTI in some scenarios. in vitro fosfomycin susceptibility testing for multiresistant KPC-Kp may be of limited clinical value. |
| format | Article |
| id | doaj-art-abe87362014f4e629d08f935a3700ce0 |
| institution | OA Journals |
| issn | 2213-7165 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj-art-abe87362014f4e629d08f935a3700ce02025-08-20T01:57:36ZengElsevierJournal of Global Antimicrobial Resistance2213-71652025-03-014113814310.1016/j.jgar.2024.12.013Efficacy of high doses of intravenous fosfomycin for treatment of urinary tract infection caused by KPC carbapenemase-producing Klebsiella pneumoniae: An observational studyJorge Rodríguez-Gómez0Irene Gracia-Ahufinger I1Rosario Carmona-Flores2Julia Guzmán-Puche3Rafael León4Elena Pérez-Nadales5Monserrat Muñoz de la Rosa6Alejandra Mendez Natera7Juan José Castón8Ángela Cano9Juan Jesús Pineda-Capitán10Cristina López11Carmen De la Fuente-Martos12Julián Torre-Cisneros13Luis Martínez-Martínez14Intensive Care Unit, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainMaimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; Microbiology Unit, Reina Sofia University Hospital, Córdoba, SpainIntensive Care Unit, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, SpainMaimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; Microbiology Unit, Reina Sofia University Hospital, Córdoba, SpainIntensive Care Unit, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainMaimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainMaimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; Microbiology Unit, Reina Sofia University Hospital, Córdoba, SpainMaimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; Infectious Diseases Unit, Reina Sofia University Hospital, Córdoba, SpainMaimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; Infectious Diseases Unit, Reina Sofia University Hospital, Córdoba, SpainMaimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; Infectious Diseases Unit, Reina Sofia University Hospital, Córdoba, SpainIntensive Care Unit, Reina Sofia University Hospital, Cordoba, SpainIntensive Care Unit, Reina Sofia University Hospital, Cordoba, SpainIntensive Care Unit, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainMaimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; Infectious Diseases Unit, Reina Sofia University Hospital, Córdoba, Spain; Department of Infectious Diseases, University of Cordoba, Cordoba, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Corresponding author. Mailing address: Reina Sofía University Hospital, UGC Enfermedades Infecciosas, Avenida Menéndez Pidal s/n, 14004 Córdoba, Spain.Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Cordoba, Spain; Microbiology Unit, Reina Sofia University Hospital, Córdoba, Spain; Department of Agricultural Chemistry, Soil Science and Microbiology, University of Cordoba, Cordoba, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, SpainABSTRACT: Objective: To evaluate the efficacy of high-dose intravenous fosfomycin for the treatment of urinary tract infections (UTI) caused by KPC carbapenemase-producing Klebsiella pneumoniae (KPC-Kp). A secondary objective was to evaluate the impact of the results of fosfomycin susceptibility testing on prognosis. Methods: This is an observational and retrospective study. Patients hospitalized with UTI caused by KPC-Kp receiving treatment with high-dose intravenous fosfomycin were evaluated from December 2012 to June 2018. The primary outcome variable was clinical cure at d 21. Results: Forty-seven patients were included. The results of commercial microdilution panels showed that KPC-Kp isolates from 14 (29.8%) and 33 (70.2%) patients were non-susceptible and susceptible to fosfomycin, respectively. In 28 available isolates, susceptibility was also determined by the reference agar dilution method. In the global cohort, clinical cure was achieved at d 21 for 33 (70.2%) out of the 47 patients, with no statistical differences found between fosfomycin non-susceptible isolates and fosfomycin susceptible isolates as determined by commercial microdilution (78.6 vs. 66.7%; P = 0.50) or by the reference agar dilution (83.3 vs. 72.7%; P = 1). In the logistic regression analysis, the Pitt index was the only variable related to clinical cure at 21 d. No statistically significant differences were found for the variables associated with fosfomycin susceptibility testing or fosfomycin minimum inhibitory concentration. Conclusions: High-dose intravenous fosfomycin can be considered for treatment of hospitalized patients with KPC-Kp UTI in some scenarios. in vitro fosfomycin susceptibility testing for multiresistant KPC-Kp may be of limited clinical value.http://www.sciencedirect.com/science/article/pii/S2213716524004764KPCCarbapenemaseFosfomycinUrinary tract infection |
| spellingShingle | Jorge Rodríguez-Gómez Irene Gracia-Ahufinger I Rosario Carmona-Flores Julia Guzmán-Puche Rafael León Elena Pérez-Nadales Monserrat Muñoz de la Rosa Alejandra Mendez Natera Juan José Castón Ángela Cano Juan Jesús Pineda-Capitán Cristina López Carmen De la Fuente-Martos Julián Torre-Cisneros Luis Martínez-Martínez Efficacy of high doses of intravenous fosfomycin for treatment of urinary tract infection caused by KPC carbapenemase-producing Klebsiella pneumoniae: An observational study Journal of Global Antimicrobial Resistance KPC Carbapenemase Fosfomycin Urinary tract infection |
| title | Efficacy of high doses of intravenous fosfomycin for treatment of urinary tract infection caused by KPC carbapenemase-producing Klebsiella pneumoniae: An observational study |
| title_full | Efficacy of high doses of intravenous fosfomycin for treatment of urinary tract infection caused by KPC carbapenemase-producing Klebsiella pneumoniae: An observational study |
| title_fullStr | Efficacy of high doses of intravenous fosfomycin for treatment of urinary tract infection caused by KPC carbapenemase-producing Klebsiella pneumoniae: An observational study |
| title_full_unstemmed | Efficacy of high doses of intravenous fosfomycin for treatment of urinary tract infection caused by KPC carbapenemase-producing Klebsiella pneumoniae: An observational study |
| title_short | Efficacy of high doses of intravenous fosfomycin for treatment of urinary tract infection caused by KPC carbapenemase-producing Klebsiella pneumoniae: An observational study |
| title_sort | efficacy of high doses of intravenous fosfomycin for treatment of urinary tract infection caused by kpc carbapenemase producing klebsiella pneumoniae an observational study |
| topic | KPC Carbapenemase Fosfomycin Urinary tract infection |
| url | http://www.sciencedirect.com/science/article/pii/S2213716524004764 |
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