Efficacy of fosfomycin in preventing infection after endoscopic combined intrarenal surgery in periods of limited supply of first‐ and second‐generation cephalosporins

Abstract

Objectives In March 2019, cefazolin was unavailable owing to difficulty in procuring the active ingredient. Furthermore, the supply of alternative drugs, such as cefotiam and cefmetazole, was limited. In the Department of Nephro‐Urology, fosfomycin‐based drugs are used as substitutes for cefazolin, which is a perioperative prophylactic antibacterial drug. Herein, we investigated the effectiveness of fosfomycin sodium and cefotiam in preventing infection after endoscopic combined intrarenal surgery as a retrospective preliminary study. Methods A total of 200 patients who underwent endoscopic combined intrarenal surgery at our department between August 2017 and January 2021 were included. The patients were administered cefotiam (n = 95) or fosfomycin (n = 105) as perioperative antibacterial agents. There were no significant differences in the median age or surgery time between the cefotiam and fosfomycin groups. Propensity score matching was performed to match the preoperative urine bacterial counts of both groups. Sixty‐eight patients were selected from each group. Results The median postoperative hospital stay duration was 4 days for the two groups. The median maximum postoperative temperatures were 37.5 and 37.4°C, respectively. There were no significant differences between the maximum postoperative temperatures in both groups. Furthermore, there were no differences between the groups regarding the white blood cell counts, C‐reactive protein levels, and aspartate aminotransferase and alanine aminotransferase levels postoperatively, as well as in terms of postoperative fever requiring additional antibiotics. Conclusions During a period of difficulty in acquiring cefazolin and cefotiam, the use of fosfomycin allowed us to continue with the procedure without increased clinical complications.

New Horizons for the Role of Fosfomycin in the Era of Multi-drug Resistant Urinary Tract Infections

“…За час застосування в клінічній практиці проведено близько 60 контрольованих клінічних досліджень застосування пероральної форми фосфоміцину при гострому циститі, а також опубліковано результати метааналізів щодо цієї теми [3,7,13,16,17,19,21,22,. Вживання разової дози 3 г препарату порівнювали з хінолонами і фторхінолонами -норфлоксацином [27,32,33,36,37,42], ципрофлоксацином [41,52], офлоксацином [29], пефлоксацином [53], нітрофуранами [16,25,38,44,54], цефалоспоринами [39,55], амінопеніцилінами [28,48] і аміноглікозидами [26], а також триметопримом [31,43] та поєднанням сульфаметоксазолу/триметоприму (TMP/SMX) [29,30].…”

“…Високу ефективність (85-92,3%) одноразового передопераційного вживання фосфоміцину продемонстрував ретроспективний порівняльний аналіз багаторічного досвіду одноразового прийому 3 г препарату до ендоскопічних урологічних маніпуляцій з урахуванням даних культуральних досліджень сечі і бактеріологічного контролю ранової інфекції, що проведений у клініці Токійського університету та медичному коледжі Кіото і Нагоя [19, 55,64,65]. Виявлено, що ефект однократної антибіотикопрофілактики фосфоміцином перед ТУР сечового міхура навіть серед хворих високого ризику відповідний застосуванню ін'єкційних цефалоспоринів [59].…”

Editorial Comment to Efficacy of fosfomycin in preventing infection after endoscopic combined intrarenal surgery in periods of limited supply of first‐ and second‐generation cephalosporins

“…The endoscopic combined intrarenal surgery that is discussed in this paper corresponds to semi-clean surgery, and Japanese guidelines recommend single doses of first-and second-generation cephalosporins, Sulbactam/Ampicillin, and Amikacin. 1 In Japan, the antimicrobial resistance (AMR) action plan was formulated at the Ministerial Meeting on Infectious Disease Control in April 2016 to reduce the isolation rate of resistant bacteria. 2 As a result index, "reduce the total amount of antibacterial agents used by 33% from the 2013 level" was listed.…”

“…Among them, the following are recommended for proper use of perioperative preventive antibacterial agents; narrow‐range antibacterial agents that also have antibacterial activity against the pathogenic microorganisms that are the source of SSI must be selected according to the classification for contamination degree of surgery, and the dosing period also be as short as possible. The endoscopic combined intrarenal surgery that is discussed in this paper corresponds to semi‐clean surgery, and Japanese guidelines recommend single doses of first‐and second‐generation cephalosporins, Sulbactam/Ampicillin, and Amikacin 1 …”