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Cerebrospinal fluid penetration of fosfomycin in patients with ventriculitis: an observational study

Christina König1,2, Jens Martens-Lobenhoffer3, Patrick Czorlich4

  • 1Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.

Annals of Clinical Microbiology and Antimicrobials
|April 24, 2023
PubMed
Abstract

Insights

Fosfomycin demonstrates high cerebrospinal fluid (CSF) penetration in ventriculitis patients, achieving therapeutic concentrations. Continuous infusion of fosfomycin is a viable option for combination antibiotic therapy in treating this infection.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Neuroscience

Background:

  • Ventriculitis treatment often uses vancomycin and meropenem, but their cerebrospinal fluid (CSF) penetration is variable, potentially leading to subtherapeutic levels.
  • Fosfomycin is a potential alternative for combination therapy, yet data on its CSF penetration are limited.

Purpose of the Study:

  • To investigate the CSF penetration of fosfomycin in adult patients with ventriculitis.
  • To determine if continuous infusion of fosfomycin achieves adequate concentrations in the CSF for effective treatment.

Main Methods:

  • Adult patients receiving continuous infusion of fosfomycin (1 g/h) for ventriculitis were enrolled.
  • Therapeutic drug monitoring of fosfomycin in serum and CSF was conducted, with dose adjustments as needed.
  • CSF penetration ratios and pharmacokinetic parameters were analyzed using collected laboratory data.

Main Results:

  • Seventeen patients provided 43 CSF/serum samples.
  • Median fosfomycin CSF concentration was 99 mg/L, with a median CSF penetration ratio of 46%.
  • 98% of CSF fosfomycin levels exceeded the susceptibility breakpoint of 32 mg/L.

Conclusions:

  • Fosfomycin exhibits high CSF penetration, ensuring concentrations effective against Gram-positive and Gram-negative bacteria.
  • Continuous administration of fosfomycin is a promising strategy for antibiotic combination therapy in ventriculitis.
  • Further research is warranted to assess the clinical outcomes associated with fosfomycin treatment for ventriculitis.
Keywords:
Cerebral Ventriculitis (D058565)Critical Care (D003422)Drug Monitoring (D016903)Fosfomycin (D005578)Pharmacokinetics (D010599)

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