Intravenous Fosfomycin as Adjunctive Therapy for Gram-Negative Bacteria Bloodstream Infections: A Propensity Score
Alessandra Belati1, Lucia Diella1, Davide Fiore Bavaro2
1Infectious Diseases Unit, IRCCS Humanitas Research Hospital, Milan, Italy.
International Journal of Antimicrobial Agents
|June 21, 2024
Summary
Intravenous fosfomycin (iv-FOS) combination therapy may improve survival for Gram-negative bacteria bloodstream infections (GNB-BSI). Further clinical trials are warranted to confirm these findings in patient populations.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Gram-negative bacteria bloodstream infections (GNB-BSI) pose a significant clinical challenge.
- Intravenous fosfomycin (iv-FOS) shows potential efficacy in vitro for GNB-BSI treatment.
- Clinical data on iv-FOS as part of combination therapy for GNB-BSI is limited.
Purpose of the Study:
- To evaluate the role of iv-FOS in combination therapy for GNB-BSI.
- To assess the impact of iv-FOS combination therapy on 30-day mortality in patients with GNB-BSI.
Main Methods:
- Retrospective analysis of consecutive patients with GNB-BSI from January 2021 to April 2023.
- Primary outcome: 30-day mortality.
- Statistical analysis included Cox regression and inverse-probability of treatment-weighting (IPTW).
Main Results:
- 363 patients were enrolled; 36% of pathogens were carbapenem-resistant.
- Iv-FOS combination therapy was used in 27% of cases.
- Multivariable and IPTW-adjusted Cox models showed iv-FOS combination therapy was associated with reduced mortality (aHR 0.51-0.52).
- A benefit was observed in severe infections and when iv-FOS was initiated within 24 hours.
Conclusions:
- Iv-FOS in combination therapy may improve survival in patients with GNB-BSI.
- These findings support further clinical investigation of iv-FOS for GNB-BSI.
- Further trials are justified to confirm the role of iv-FOS in GNB-BSI treatment.
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