Fosfomycin-Trometamol for Urinary Tract Infections in Kidney Transplant Recipients

Background The treatment of urinary tract infections (UTI's) 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 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 53 episodes in 40 KTRs were included (ASB n=15; lower-UTI n=33; upper-UTI n=5). FT was used for a median short duration in a heterogeneous gift interval. FT 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 failure. Acquired resistance to fosfomycin was observed in 6 episodes. Conclusions FT has a reasonable effectiveness as last-resort oral treatment for lower-UTI and stepdown treatment for upper-UTI in KTRs. Randomized controlled trials with optimal dosage regimens are warranted. Use of FT is not recommended for ASB. Authorship: TD, HW, SM, JS and MB participated in the research design. TD and JS participated in the collection of the data. TD and HW participated in the data analysis. All authors participated in the writing of the paper. Disclosure: The authors declare no conflicts of interest. Funding: No funding was received for this work. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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