DI-039 Fosfomycin trometamol use in a third level hospital

BackgroundFosfomycin trometamol is a broad spectrum antibiotic used in uncomplicated, low urinary tract infections (UTI) in women.PurposeTo describe the use of fosfomycin trometamol in UTI in a third level hospital.Material and methodsHospitalised patients receiving treatment with fosfomycin trometamol between May 2015 and September 2016 were investigated. Demographic and clinical records, microbial cultures and antibiotic use were collected retrospectively. Indication and treatment duration were evaluated according to the hospital’s empirical antibiotic treatment guidelines.Results54 patients were included, 45 women (83.33%), mean age 68.29 years (range 22.85–91.59). 49 patients (90.74%) were hospitalised in medical units and 5 (9.26%) in surgical units. 14 patients (25.93%) had a urinary catheter, removed in 6 patients (not recorded in the others). 32 patients (59.26%) had a urinary culture requested, of which: 28 (87.5%) were positive (27 were sensitive to fosfomycin, 1 resistant) and 4 (14.29%) were negative. Bacterial isolates were: E coli in 64.29% (18/28) of cultures, of which 27.78% (5/18) were extended spectrum β-lactamase producing E coli (ESBL); Klebsiella pneumoniae in 10.71% (3/28); Proteus mirabilis in 7.14% (2/28); Pseudomonas aeruginosa in 3.57% (1/28); and 14.29% (4/28) were mixed cultures. In 34 patients (62.96%) were treated empirically, 20 (37.04%) were targeted treatments and none was used as prophylaxis. 25 patients (40.30%) received a single dose, 15 (27.78%) patients received 2 doses and 14 (25.93%) patients received from 3 to 10 doses. Fosfomycin trometamol was used in symptomatic bacteriuria in 38.89% (21/54) of patients, in low UTI in 59.26% (32/54) of patients and in urinary sepsis in 1.85% (1/54) of patients. According to the hospital’s empirical antibiotic treatment guidelines, fosfomycin trometamol should be used as a 3 g single oral dose, or two doses 24–72 hours apart, for the treatment of UTI in women. Asymptomatic bacteriuria should not be treated unless pregnancy, neutropenia and antimicrobial prophylaxis in specific procedures. Urinary catheter should always be replaced in ITU. According to the hospital’s guide, fosfomycin trometamol was not indicated in 37.03% (20/54) of patients. Treatment duration was inadequate in 33.33% of patients (18/54). Only 6 patients had urinary catheter replacement.ConclusionFosfomycin trometamol is a broad spectrum antibiotic which was not adequately used in our hospital (in terms of indica