Current clinical use of intravenous fosfomycin in ICU patients in two European countries

Purpose In Europe, intravenous fosfomycin (IV) is used particularly in difficult-to-treat or complex infections, caused by both Gram-positive and Gram-negative pathogens including multidrug-resistant strains. Here, we investigated the efficacy and safety of intravenous fosfomycin under real-life con...

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Bibliographic Details
Published in:Infection 2019-10, Vol.47 (5), p.827-836
Main Authors: Putensen, C., Ellger, B., Sakka, S. G., Weyland, A., Schmidt, K., Zoller, M., Weiler, N., Kindgen-Milles, D., Jaschinski, U., Weile, J., Lindau, S., Kieninger, M., Faltlhauser, A., Jung, N., Teschendorf, P., Adamzik, M., Gründling, M., Wahlers, T., Gerlach, H., Litty, F.-A.
Format: Article
Language:English
Subjects:
Administration, Intravenous
Adult
Aged
Anti-Bacterial Agents - administration & dosage
Antibiotics
Austria
Bacteremia
Bacterial infections
Bacterial Infections - drug therapy
Critical Illness
E coli
Family Medicine
Female
Females
Fosfomycin
Fosfomycin - administration & dosage
General Practice
Germany
Hospitals
Humans
Infections
Infectious Diseases
Intensive care
Intensive Care Units
Internal Medicine
Intravenous administration
Klebsiella
Male
Males
Medicine
Medicine & Public Health
Middle Aged
Multidrug resistance
Multidrug resistant organisms
Original Paper
Pathogens
Patients
Pneumonia
Prospective Studies
Sepsis
Sepsis - drug therapy
Sepsis - microbiology
Therapy
Treatment Outcome
Ventilator-associated pneumonia
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Summary:Purpose In Europe, intravenous fosfomycin (IV) is used particularly in difficult-to-treat or complex infections, caused by both Gram-positive and Gram-negative pathogens including multidrug-resistant strains. Here, we investigated the efficacy and safety of intravenous fosfomycin under real-life conditions. Methods Prospective, multi-center, and non-interventional study in patients with bacterial infections from 20 intensive care units (ICU) in Germany and Austria (NCT01173575). Results Overall, 209 patients were included (77 females, 132 males, mean age: 59 ± 16 years), 194 of which were treated in intensive care (APACHE II score at the beginning of fosfomycin therapy: 23 ± 8). Main indications (± bacteremia or sepsis) were infections of the CNS (21.5%), community- (CAP) and hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP, 15.3%), bone and joint infections (BJI, 11%), abdominal infections (11%), and bacteremia (10.5%). Most frequently identified pathogens were S. aureus (22.3%), S. epidermidis (14.2%), Enterococcus spp. (10.8%), E. coli (12.3%) and Klebsiella spp. (7.7%). At least one multidrug-resistant (MDR) pathogen was isolated from 51 patients (24.4%). Fosfomycin was administered with an average daily dose of 13.7 ± 3.5 g over 12.4 ± 8.6 days, almost exclusively (99%) in combination with other antibiotics. The overall clinical success was favorable in 81.3% (148/182) of cases, and in 84.8% (39/46) of patients with ≥ 1 MDR pathogen. Noteworthy, 16.3% (34/209) of patients developed at least one, in the majority of cases non-serious, adverse drug reaction during fosfomycin therapy. Conclusion Our data suggest that IV fosfomycin is an effective and safe combination partner for the treatment of a broad spectrum of severe bacterial infections in critically ill patients.
ISSN:0300-8126
1439-0973
DOI:10.1007/s15010-019-01323-4