Fosfomycin in the treatment of extended spectrum beta-lactamase-producing Enterobacteriaceae- related urinary tract infections

Introduction: We aimed to demonstrate if fosfomycin tromethamine (FT) treatment could be the treatment of choice in ESBL-producing Enterobacteriaceae strains as an alternative to carbapenem particularly in patients who we would like to treat on an outpatient basis. Methodology; We retrospectively analyzed the medical records of all patients who admitted to infectious disease outpatient clinic with complaints of dysuria and frequency and received FT for lower UTI between May 2016 and May 2017. Results: A total of 48 patients, 19 females (39.6%) and 29 males (60.4%), with a mean age of 62.5 (ranging from 27 to 85) years were included the study. 26 (76.4%) of patients with a history of urinary operation or intervention had also a history of antibiotic use within the past 3 months. The isolated pathogens included Escherichia Coli (n = 32), Klebsiella spp. (n = 12), Enterobacter spp. (n = 4). The overall microbiological response after treatment was 70.8% (34/48) and the clinical response was 75% (36/48). Clinical and microbiological response rates of patients with and without urinary operation/intervention, diabetes mellitus, history of antibiotic use and malignancy were found similar (p > 0.05). However, patients with a urinary stone disease history had significantly higher response rates than those without a urinary stone disease history (P = 0.042). Conclusion: Oral fosfomycin tromethamine might be the treatment of choice in ESBL-producing enterobactericea related UTIs especially caused by Escherichia Coli.