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Oral fosfomycin for the treatment of lower urinary tract infections among kidney transplant recipients—Results of a Spanish multicenter cohort
Author(s) -
LópezMedrano Francisco,
Silva José Tiago,
FernándezRuiz Mario,
Vidal Elisa,
Origüen Julia,
CalvoCano Antonia,
LunaHuerta Enrique,
Merino Esperanza,
Hernández Domingo,
JirondaGallegos Cristina,
Escudero Rosa,
Gioia Francesca,
Moreno Antonio,
Roca Cristina,
Cordero Elisa,
Janeiro Darío,
SánchezSobrino Beatriz,
Montero María Milagro,
Redondo Dolores,
Candel Francisco Javier,
PérezFlores Isabel,
Armiñanzas Carlos,
González-Rico Claudia,
Fariñas María Carmen,
Rodrigo Emilio,
Loeches Belén,
LópezOliva María O.,
Montejo Miguel,
Lauzurica Ricardo,
Horcajada Juan Pablo,
Pascual Julio,
Andrés Amado,
Aguado José María
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15614
Subject(s) - medicine , fosfomycin , interquartile range , urinary system , confidence interval , odds ratio , retrospective cohort study , surgery , urology , antibiotics , microbiology and biotechnology , biology
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.