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Intravenous Fosfomycin for Difficult-to-Treat Infections: A Real-Life Multicentric Study in Italy
Verena Zerbato1, Gianfranco Sanson2, Lisa Fusaro2
1Infectious Diseases Unit, Trieste University Hospital (ASUGI), 34125 Trieste, Italy.
Abstract:
Background: Fosfomycin, an old antibiotic attracting renewed interest, offers a broad spectrum of activity and unique synergy with other agents. While widely used in severe infections, real-world data on intravenous fosfomycin remain limited. Objectives: This study aimed to describe the clinical and microbiological characteristics of patients treated with intravenous fosfomycin and to analyze its administration modalities in a real-world setting. Methods: A multicenter retrospective cohort study was conducted across five Italian hospitals. Adult patients receiving intravenous fosfomycin between January 2020 and December 2023 were included. Results: We enrolled 393 patients. The median age was 69 years, with most patients (45%) admitted to Critical Care Units. Pneumonia (34%), bloodstream infections (22%), and urinary tract infections (21%) were the most common indications. Gram-negative bacteria, particularly E. coli and P. aeruginosa, were the predominant pathogens. Fosfomycin was used as empirical therapy in 55% of cases and was combined with other agents in almost all cases (99%). The most frequent partners were piperacillin/tazobactam (21%) and new beta-lactam/beta-lactamase inhibitor combinations (18%). The median treatment duration was seven days, with most subjects (65%) receiving a fosfomycin dosage regimen of 16 g/day. Minimum inhibitory concentrations (MICs) values for fosfomycin were available for 61 isolates (15%), with 78.7% (48/61) showing MIC ≤ 32 mg/L. C. difficile infection occurred in only 2% of patients. Mortality rates at 30, 60, and 90 days were 21.6%, 26.7%, and 29.3%, respectively. Conclusions: This study provides valuable insights into the real-world use of intravenous fosfomycin.
Insights
Intravenous fosfomycin is increasingly used for severe infections, often in combination therapy. This study details its real-world administration, patient characteristics, and outcomes in Italian hospitals.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Microbiology
Background:
- Fosfomycin, an antibiotic with broad-spectrum activity and synergistic potential, is gaining renewed interest for treating severe infections.
- Real-world data on the clinical use of intravenous fosfomycin, especially in combination therapies, remain limited.
- Understanding its administration and effectiveness in diverse patient populations is crucial for optimizing treatment strategies.
Purpose of the Study:
- To characterize clinical and microbiological profiles of patients receiving intravenous fosfomycin.
- To analyze the administration modalities and treatment outcomes of intravenous fosfomycin in a real-world setting.
- To provide evidence supporting the use of intravenous fosfomycin in complex infections.
Main Methods:
- Multicenter retrospective cohort study across five Italian hospitals.
- Inclusion of adult patients treated with intravenous fosfomycin from January 2020 to December 2023.
- Data collection on patient demographics, infection types, pathogen prevalence, combination therapies, dosages, and outcomes.
Main Results:
- 393 patients were analyzed, with a median age of 69 years; most were in Critical Care Units.
- Common indications included pneumonia (34%), bloodstream infections (22%), and urinary tract infections (21%), predominantly caused by Gram-negative bacteria.
- Fosfomycin was frequently used empirically (55%) and in combination therapy (99%), with piperacillin/tazobactam and new beta-lactam/beta-lactamase inhibitors being common partners.
Conclusions:
- This study offers significant real-world insights into intravenous fosfomycin usage in Italian hospitals.
- Intravenous fosfomycin is a versatile agent, often employed in combination for severe Gram-negative infections.
- Further research should focus on optimizing dosing and evaluating long-term efficacy and safety profiles.
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