The use of oral fosfomycin-trometamol in patients with catheter-associated urinary tract infections (CAUTI): new indications for an old antibiotic?

Abstract

We present the results of a multicenter retrospective study of 35 difficult-to-treat patients with urinary tract infections associated with indwelling urinary catheters (CAUTIs). All patients received oral administration of 3 g fosfomycin trometamol once a day for two days and then with a dose of 3 g every 48 h for two weeks. The most commonly isolated strains were: Escherichia coli (65.7%) and Enterococcus spp. (25.7%); prevalence of Extended-Spectrum Beta-Lactamase strains was 48.5%. Six patients (17.1%) had a clinical response after a single dose of fosfomycin trometamol, 12 (34.2%) after two doses and 13 (37.1%) patients had a clinical response after three or more doses. Four patients (11.6%) failed prolonged antibiotic treatment with fosfomycin trometamol. During the follow-up period, 30 out of 35 (85.7%) patients were without symptomatic infections. No significant side effects were reported. In conclusion, fosfomycin trometamol seems to be a valid treatment option in patients with CAUTIs.

Keywords:

• Fosfomycin trometamol
• CAUTI
• complicated urinary tract infection
• antibiotic stewardship

Acknowledgements

We are grateful to all members of the microbiological departments in all centers for their assistance and to Juliet Ippolito for manuscript language revision.

Conflict of interest

The authors report no declarations of interest.

Notes on contributors

Tommaso Cai is consultant of Urology at the Department of Urology, Santa Chia a Regional Hospital, Trento, Italy; he is a member of EAU Section of Infections in Urology (ESIU), EAU guideline office on Urological Infections and member of Infection and Inflammation group of SIU-Academy.

Andrea Cocci is urologist at University of Floence.

Paolo Verze is assistant Professor at Department of Urology, University of Naples, Federico II; he is member of EAU guideline office on Male Sexual Health.

Michele Rizzo is consultant Urologists at the Department of Urology, University of Trieste.

Alessandro Palmieri is Professor of Urology at the Department of Urology, University of Naples, Federico II and he is the Presidet of Italian Society of Andrology.

Giovanni Liguori is Professor of Urology at the Department of Urology, University of Trieste.

Carlo Trombetta is Professor of Urology and Director of the Department of Urology, University of Trieste.

Chiara Adembri is Professor of Anesthesiology at the Department of Health Sciences, Section of Anesthesiology and Critical Care, University of Florece, Florence.

Marco Carini is Full Professor of Urology and Director of Department of Urology, University of Florence.

Riccardo Bartoletti is Full Professor of Urology at the Univeristy of Pisa, member of EAU Section of Infections in Urology (ESIU) and EAU guideline office on Urological Infections.

Florian M. Wagenlehner is Full Professor of Urology at the Klinik und Poliklinik fu?r Urologie, Kinderurologie und Andrologie, Universitätsklinikum Giessen und Marburg GmbH, Justus-Liebig-Universität Giessen, Giessen, Germany; he is Chairman of the EAU Section of Infections in Urology (ESIU) and member of EAU guideline office on Urological Infections.

Gernot Bonkat is Professor of Urology at the University Basel, Basel, Switzerland. He is Chairman of EAU guideline office on Urological Infections and member of EAU Section of Infections in Urology (ESIU).

Vincenzo Mirone is Full Professor of Urology at the Department of Urology, University of Naples, Federico II and Chairman of EAU European Urological Scholarship Programme Office.

Truls E. Bjerklund Johansen is Full Professor of Urology at the Department of Urology, Oslo University Hospital and University of Oslo, Oslo, Norway; he is member of EAU Section of Infections in Urology (ESIU).

Andrea Novelli is Full Professor of Pharmacology at the Department of Health Sciences, University of Florence, Florence and he is the Editor of Journal of Chemotherapy.