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. 2023 May 27;12(6):971.
doi: 10.3390/antibiotics12060971.

The Use of Intravenous Fosfomycin in Clinical Practice: A 5-Year Retrospective Study in a Tertiary Hospital in Italy

Antonio Anastasia  1   2 , Silvia Bonura  2   3 , Raffaella Rubino  2   3 , Giovanni Maurizio Giammanco  1   3   4 , Irene Miccichè  3   5 , Maria Rita Di Pace  1 , Claudia Colomba  1 , Antonio Cascio  1   2   3
Affiliations

The Use of Intravenous Fosfomycin in Clinical Practice: A 5-Year Retrospective Study in a Tertiary Hospital in Italy

Antonio Anastasia et al. Antibiotics (Basel). .

Abstract

Fosfomycin in intravenous (IV) formulation has re-emerged as a valuable tool in the treatment of multi-drug resistant (MDR) and extensively drug-resistant (XDR) infections because of its broad spectrum of antibacterial action and pharmacokinetic characteristics. This retrospective study aimed to evaluate how fosfomycin was used in patients admitted to the Polyclinic of Palermo between January 2017 and July 2022. Clinical indications, therapeutic associations, clinical outcomes, and any side effects were analyzed. Intravenous fosfomycin was used in 343 patients, 63% male, with a mean age of 68 years (range 15-95). Urinary tract infections (UTIs) and hospital-acquired pneumonia (HAP) were the main indications for treatment (19% and 18% of the total cases, respectively), followed by skin and soft tissue infections and sepsis. IV fosfomycin was administered in combination with other antibacterial agents, the most common of which were ceftazidime/avibactam (35%), meropenem (17%), and colistin (14%). Nineteen patients received it as monotherapy for UTIs. About 66% had resolution of the infectious process with clinical remission (cure or discharge). Electrolyte disturbances occurred in 2.6% and gastrointestinal symptoms occurred in 2.9%. The data showed that IV fosfomycin is a safe and effective therapeutic option in the treatment of infections with multidrug-resistant microorganisms.

Keywords: antimicrobials; fosfomycin; gram-negative; retrospective study.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Indications for fosfomycin use. UTIs = urinary tract infections; IAIs = intra-abdominal infections; BSI = bloodstream infections; CNS inf. = central nervous system infections; SSTI = skin and soft tissue infections.
Figure 2
Figure 2
Main microbiological isolates.
Figure 3
Figure 3
Prevalence of K.pneumoniae isolates sensitive to respective molecules in the extended antibiograms to the aforementioned antibiotics. Data shown as the percentages and number of susceptible strains/total isolates. TPM/SMX = trimethoprim–sulfamethoxazole CAZ/AVI = ceftazidime/avibactam MER/VAB = meropenem/vaborbactam CEF/TAZ = ceftolozane/tazobactam.
Figure 4
Figure 4
Prevalence of A. baumannii isolates sensitive to the respective molecules in the extended antibiograms to the aforementioned antibiotics. Data shown as the percentages and number of susceptible strains/total isolates. FQ = fluoroquinolones; AG = aminoglycoside; TPM/SMX = trimethoprim–sulfamethoxazole.
See this image and copyright information in PMC

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