Efficacy and Safety of Oral Fosfomycin for Asymptomatic Bacteriuria in Kidney Transplant Recipients: Results from a Spanish Multicenter Cohort
Por:
Ruiz-Ruigomez, M, Fernandez-Ruiz, M, Silva, J, Vidal, E, Origuen, J, Calvo-Cano, A, Luna-Huerta, E, Merino, E, Hernandez, D, Jironda-Gallegos, C, Escudero-Sanchez, R, Gioia, F, Moreno, A, Roca, C, Cordero, E, Janeiro, D, Sanchez-Sobrino, B, Montero, M, Redondo, D, Candel, F, Perez-Flores, I, Arminanzas, C, Gonzalez-Rico, C, Farinas, M, Rodrigo, E, Loeches, B, Lopez-Oliva, M, Montejo, M, Lauzurica, R, Horcajada, J, Pascual, J, Andres, A, Aguado, J, Lopez-Medrano, F and REIPI Redinren GESITRA-IC SEIMC
Publicada:
1 may 2021
Ahead of Print:
8 feb 2021
Resumen:
Current guidelines recommend against systematic screening for or treating asymptomatic bacteriuria (AB) among kidney transplant (KT) recipients, although the evidence regarding episodes occurring early after transplantation or in the presence of anatomical abnormalities is inconclusive. Oral fosfomycin may constitute a good option for the treatment of posttransplant AB, particularly due to the emergence of multidrug-resistant (MDR) uropathogens. Available clinical evidence supporting its use in this specific setting, however, remains scarce. We performed a retrospective study in 14 Spanish institutions from January 2005 to December 2017. Overall, 137 episodes of AB diagnosed in 133 KT recipients treated with oral fosfomycin (calcium and trometamol salts) with a test-of-cure urine culture within the first 30 days were included. Median time from transplantation to diagnosis was 3.1 months (interquartile range [IQR], 1.1 to 10.5). Most episodes (96.4% [132/137]) were caused by Gram-negative bacteria (GNB), and 56.9% (78/137) were categorized as MDR (extended-spectrum beta-lactamase-producing Enterobacterales [20.4%] and carbapenem-resistant GNB [2.9%]). Rate of microbiological failure at month 1 was 40.1% (95% confidence interval [CI], 31.9% to 48.9%) for the whole cohort and 42.3% (95% CI, 31.2% to 54.0%) for episodes due to MDR pathogens. Previous urinary tract infection (odds ratio [OR], 2.42; 95% CI, 1.11 to 5.29; P value = 0.027) and use of fosfomycin as salvage therapy (OR, 8.31; 95% CI, 1.67 to 41.35; P value = 0.010) were predictors of microbiological failure. No severe treatment-related adverse events were detected. Oral fosfomycin appears to be a suitable and safe alternative for the treatment (if indicated) of AB after KT, including those episodes due to MDR uropathogens.
Filiaciones:
Ruiz-Ruigomez, M:
Univ Hosp 12 Octubre, Hosp 12 Octubre Imas12, Unit Infect Dis, Inst Invest Biomed, Madrid, Spain
Fernandez-Ruiz, M:
Univ Hosp 12 Octubre, Hosp 12 Octubre Imas12, Unit Infect Dis, Inst Invest Biomed, Madrid, Spain
Silva, J:
Univ Hosp 12 Octubre, Hosp 12 Octubre Imas12, Unit Infect Dis, Inst Invest Biomed, Madrid, Spain
Vidal, E:
Univ Cordoba, Univ Hosp Reina Sofia, Inst Maimonides Invest Biomed Cordoba IMIBIC, Unit Infect Dis, Cordoba, Spain
Origuen, J:
Univ Hosp 12 Octubre, Hosp 12 Octubre Imas12, Dept Emergency Med, Inst Invest Biomed, Madrid, Spain
Calvo-Cano, A:
Univ Hosp Badajoz, Dept Infect Dis, Badajoz, Spain
Luna-Huerta, E:
Univ Hosp Badajoz, Dept Nephrol, Badajoz, Spain
:
Gen Univ Hosp Alicante, Inst Invest Sanitaria & Biomed Alicante ISABIAL, Unit Infect Dis, Alicante, Spain
Hernandez, D:
Univ Malaga, Reg Univ Hosp Carlos Haya, Inst Invest Biomed Malaga IBIMA, Dept Nephrol,Red Invest Renal REDinREN, RD16-0009-0006, Malaga, Spain
Jironda-Gallegos, C:
Univ Malaga, Reg Univ Hosp Carlos Haya, Inst Invest Biomed Malaga IBIMA, Dept Nephrol,Red Invest Renal REDinREN, RD16-0009-0006, Malaga, Spain
Escudero-Sanchez, R:
Univ Hosp Ramon y Cajal, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Dept Infect Dis, Madrid, Spain
Gioia, F:
Univ Hosp Ramon y Cajal, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Dept Infect Dis, Madrid, Spain
Moreno, A:
Univ Seville, Clin Unit Infect Dis Microbiol & Prevent Med, Inst Biomed Seville IBIS, CSIC,Univ Hosp Virgen Rocio,Infect Dis Res Grp, Seville, Spain
Roca, C:
Univ Seville, Clin Unit Infect Dis Microbiol & Prevent Med, Inst Biomed Seville IBIS, CSIC,Univ Hosp Virgen Rocio,Infect Dis Res Grp, Seville, Spain
Cordero, E:
Univ Seville, Clin Unit Infect Dis Microbiol & Prevent Med, Inst Biomed Seville IBIS, CSIC,Univ Hosp Virgen Rocio,Infect Dis Res Grp, Seville, Spain
Univ Seville, Dept Med, Seville, Spain
Janeiro, D:
Univ Hosp Puerta Hierro Majadahonda, Inst Invest Sanitaria Puerta Hierro Segovia Arana, Dept Nephrol, Majadahonda, Spain
Sanchez-Sobrino, B:
Univ Hosp Puerta Hierro Majadahonda, Inst Invest Sanitaria Puerta Hierro Segovia Arana, Dept Nephrol, Majadahonda, Spain
Montero, M:
Hosp del Mar, Inst Hosp Mar Invest Med IMIM, Dept Infect Dis, Barcelona, Spain
Redondo, D:
Hosp del Mar, Inst Hosp Mar Invest Med IMIM, Dept Nephrol, Barcelona, Spain
Candel, F:
Univ Complutense, Inst Invest Sanitaria San Carlos IdISSC, Dept Clin Microbiol & Infect Dis, Hosp Clin Univ San Carlos,Sch Med,Transplant Coor, Madrid, Spain
Perez-Flores, I:
Univ Complutense, Sch Med, Inst Invest Sanitaria San Carlos IdISSC, Hosp Clin Univ San Carlos,Dept Nephrol, Madrid, Spain
Arminanzas, C:
Univ Cantabria, Univ Hosp Marques Valdecilla, Inst Invest Marques Valdecilla IDIVAL, Dept Infect Dis, Santander, Spain
Gonzalez-Rico, C:
Univ Cantabria, Univ Hosp Marques Valdecilla, Inst Invest Marques Valdecilla IDIVAL, Dept Infect Dis, Santander, Spain
Farinas, M:
Univ Cantabria, Univ Hosp Marques Valdecilla, Inst Invest Marques Valdecilla IDIVAL, Dept Infect Dis, Santander, Spain
Rodrigo, E:
Univ Cantabria, Univ Hosp Marques Valdecilla, Inst Invest Marques Valdecilla IDIVAL, Dept Nephrol, Santander, Spain
Loeches, B:
Hosp Univ La Paz IdiPAZ, Univ Hosp La Paz, Dept Microbiol, Inst Invest, Madrid, Spain
Lopez-Oliva, M:
Hosp Univ La Paz IdiPAZ, Univ Hosp La Paz, Dept Nephrol, Inst Invest, Madrid, Spain
Montejo, M:
Univ Basque Country, Univ Hosp Cruces, Unit Infect Dis, Baracaldo, Spain
Lauzurica, R:
Univ Hosp Germans Trias & Pujol, Dept Nephrol, Barcelona, Spain
Horcajada, J:
Hosp del Mar, Inst Hosp Mar Invest Med IMIM, Dept Infect Dis, Barcelona, Spain
Pascual, J:
Hosp del Mar, Inst Hosp Mar Invest Med IMIM, Dept Nephrol, Barcelona, Spain
Andres, A:
Univ Hosp 12 Octubre, Hosp 12 Octubre Imas12, Dept Nephrol, Inst Invest Biomed, Madrid, Spain
Univ Complutense, Sch Med, Dept Med, Madrid, Spain
Aguado, J:
Univ Hosp 12 Octubre, Hosp 12 Octubre Imas12, Unit Infect Dis, Inst Invest Biomed, Madrid, Spain
Univ Complutense, Sch Med, Dept Med, Madrid, Spain
Lopez-Medrano, F:
Univ Hosp 12 Octubre, Hosp 12 Octubre Imas12, Unit Infect Dis, Inst Invest Biomed, Madrid, Spain
Univ Complutense, Sch Med, Dept Med, Madrid, Spain
Green Published
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