Oral fosfomycin for the treatment of lower urinary tract infections among kidney transplant recipients—Results of a Spanish multicenter cohort

Abstract

Oral fosfomycin may constitute an alternative for the treatment of lower urinary tract infections (UTIs) in kidney transplant recipients (KTRs), particularly in view of recent safety concerns with fluroquinolones. Specific data on the efficacy and safety of fosfomycin in KTR are scarce. We performed a retrospective study in 14 Spanish hospitals including KTRs treated with oral fosfomycin (calcium and trometamol salts) for posttransplant cystitis between January 2005 and December 2017. A total of 133 KTRs developed 143 episodes of cystitis. Most episodes (131 [91.6%]) were produced by gram‐negative bacilli (GNB), and 78 (54.5%) were categorized as multidrug resistant (including extended‐spectrum β‐lactamase‐producing Enterobacteriaceae [14%] or carbapenem‐resistant GNB [3.5%]). A median daily dose of 1.5 g of fosfomycin (interquartile range [IQR]: 1.5‐2) was administered for a median of 7 days (IQR: 3‐10). Clinical cure (remission of UTI‐attributable symptoms at the end of therapy) was achieved in 83.9% (120/143) episodes. Among those episodes with follow‐up urine culture, microbiological cure at month 1 was achieved in 70.2% (59/84) episodes. Percutaneous nephrostomy was associated with a lower probability of clinical cure (adjusted odds ratio: 10.50; 95% confidence interval: 0.98‐112.29; P = 0.052). In conclusion, fosfomycin is an effective orally available alternative for treating cystitis among KTRs.

Extended‐spectrum β‐lactamase‐producing and carbapenem‐resistant Enterobacterales bloodstream infection after solid organ transplantation: Recent trends in epidemiology and therapeutic approaches

“…A multicenter retrospective study performed in Spain included 143 episodes of uncomplicated UTI (cystitis) in KT recipients treated with oral fosfomycin, with rates of clinical and microbiological cure of 83.9% and 70.2%, respectively. Half of the isolates had an MDR phenotype (ESBL‐E in 14.0%, CRE in 3.5%), although the odds of microbiological cure were not decreased in these episodes (71.4%) 114 . Similar results have been also reported for asymptomatic bacteriuria within the first post‐transplant months 115 .…”

Urinary Tract Infections in Kidney Transplant Recipients—Is There a Need for Antibiotic Stewardship?

“…Nearly all isolated bacteria in our study cohort had a “weak spot” to one of these agents. These agents will grow in popularity given that they are safe and effective even against MRGN bacteria [ 46 , 47 ]. In our study cohort, not a single strain of E. coli was resistant to Fosfomycin or Nitrofurantoin, while over 40% were resistant to TMP-SMX.…”

Guidance of antibiotic treatment for urinary tract infections in the early postoperative phase after Kidney Transplantation

“…These agents will grow in popularity given they appear to be safe and e cient even in ESBL bacteria. [17,23] Furthermore after the recommendation to avoid uorchinolones in kidney transplant recipients they are also the only valid oral option for outpatient treatment.…”