Fosfomycin-trometamol for Urinary Tract Infections in Kidney Transplant Recipients
Abstract
BACKGROUND: The treatment of urinary tract infections (UTIs) in kidney transplant recipients (KTRs) with oral antibiotics is complicated by increasing resistance to trimethoprim-sulfamethoxazole, amoxicillin/clavulanic acid, and ciprofloxacin. Fosfomycin-trometamol (FT) could be an alternative, but evidence on clinical effectiveness is scarce. We evaluated the use, effectiveness and safety of FT for UTI in KTRs.
METHODS: Data were retrospectively collected in 2 Dutch transplant hospitals from adult KTRs that were treated with FT as initial treatment for lower UTI or asymptomatic bacteriuria (ASB) or as stepdown treatment for upper UTI after initial intravenous antibiotics. Exclusion criteria were in vitro resistance to FT or concomitant antibiotic treatment. Endpoints were clinical cure within 14 days and severe clinical failure, microbiological cure, relapse, recurrence, and acquired resistance within 90 days postend of treatment.
RESULTS: Fifty-three episodes in 40 KTRs were included (ASB, n = 15; lower UTI, n = 33; upper UTI, n = 5). Fosfomycin-trometamol was used for a median short duration in a heterogeneous gift interval. Fosfomycin-trometamol resulted in microbiological cure in 25%, 28%, and 100% of ASB, lower UTI and upper UTI with initial positive culture and follow-up culture performed, respectively. Clinical cure rates were 67% for lower UTI and 80% for upper UTI. Relapses or recurrences occurred in 31% and 24% of symptomatic UTI episodes, without severe clinical…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 33 participants or records.
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