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Efficacy and Safety of Oral Fosfomycin for Asymptomatic Bacteriuria in Kidney Transplant Recipients: Results from a Spanish Multicenter Cohort

Abstract: 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 ??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.

 Fuente: Antimicrob Agents Chemother 19 April 2021 65:e02267-20

Editorial: American Society for Microbiology

 Fecha de publicación: 19/04/2021

Tipo de publicación: Artículo de Revista

 DOI: doi.org/10.1128/AAC.02267-20

ISSN: 0066-4804,1098-6596,1070-6283

Url de la publicación: https://doi.org/10.1128/AAC.02267-20

Autores/as

RUIZ RUIGÓMEZ, MARÍA

FERNÁNDEZ-RUIZ, MARIO

TIAGO SILVA, JOSÉ

VIDAL, ELISA

ORIGÜEN, JULIA

CALVO CANO, ANTONIA

LUNA HUERTA, ENRIQUE

MERINO, ESPERANZA

HERNÁNDEZ, DOMINGO

JIRONDA-GALLEGOS, CRISTINA

ESCUDERO SÁNCHEZ, ROSA

GIOIA, FRANCESCA

MORENO, ANTONIO

ROCA, CRISTINA

CORDERO, ELISA

JANERIO, DARÍO

CARLOS ARMIÑANZAS CASTILLO