|Tipo di tesi||Tesi di laurea magistrale|
|Titolo||FOSFOMICINA ENDOVENOSA IN REGIME COMBINATO COME OPZIONE DI TRATTAMENTO PER LE INFEZIONI DA BATTERI GRAM- RESISTENTI AI CARBAPENEMI: A REAL LIFE EXPERIENCE|
|Titolo in inglese||INTRAVENOUS FOSFOMYCIN IN COMBINATION REGIMEN AS A TREATMENT OPTION FOR CARBAPENEM-RESISTANT GRAM- BACTERIAL INFECTIONS: A REAL LIFE EXPERIENCE|
|Struttura||Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze|
|Corso di studi||MEDICINA E CHIRURGIA (D.M.270/04)|
|Data inizio appello||2022-10-13|
|Disponibilità||Embargo di 12 mesi|
|Data di rilascio||2023-10-13|
Introduzione: Al di là degli studi in vitro, la sinergia della fosfomicina con i farmaci di "prima linea" contro i batteri Gram-negativi multiresistenti (MDR) è stata poco studiata nella pratica clinica.
Background: Outside in vitro studies, the real-world synergy of Fosfomycin with the “first-line” drugs against multidrug-resistant (MDR) Gram-negative bacteria (GNB) was under investigated. Methods: We reviewed the efficacy and safety of intravenous (IV) fosfomycin for the treatment of infections caused by GNB with MDR profiles including carbapenemase-producing ones. Data were retrospectively analyzed for all hospitalized patients who received IV fosfomycin for ≥72 h for the treatment of a MDR GNB between March 1, 2019, and March 1, 2022. Results: A total of 70 patients were included, of which 81.4% were males, and the median age was 69 years (IQR 61-73). The median Charlson Comorbidity Score was 4 (IQR 3-6) and the median SOFA score was 8 (IQR 6, 14) with 24.3% septic shocks. The pulmonary tract (42%) was the most common site of infection, and the most frequent target organisms were Pseudomonas aeruginosa (57,1%), Klebsiella pneumoniae (22.8%), and Escherichia coli (14.2%), among which more than half were carbapenem-resistant and the remaining resistant to third generation cephalosporins. The most widely used antibiotic in combination with fosfomycin was ceftazidime/avibactam (30%) followed by meropenem (20%). Clinical cure at end on treatment was observed in 39 (55,7%), while microbiolgical cure in 31 (44,3%). 30 and 90-day all-cause mortality was 11 (15,7%) and 22 (31,4%) respectively. Relapse occurred in 17 (24,2%) of the patient with documented emergent resistance to fosfomycin in 5 (29%) of these patients. Conclusions: Our results confirm the effective role of Fosfomycin in gram-negative infections with difficult resistance profiles. In combination with the “first-line” drugs it allows to overcome therapeutic limits due to high inoculum, limited sensitivity, or hard-to-reach sites such as the lung or bone or central nervous system. Randomized trials pathogen and site focused are urgently required to demonstrate the superiority of IV fosfomycin in combinations with other agents among these MDR-GNB infections.