Coronado-Álvarez Nieves M, Parra Diego, Parra-Ruiz Jorge
Laboratorio de Investigación Anti Microbiana LIAM, Hospital Inmaculada, Grupo HLA SLU, Granada, Spain.
Instituto Universitario de Oncología del Principado de Asturias, Fundación Bancaria Caja de Ahorros de Asturias, Spain; Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Spain.
Enferm Infecc Microbiol Clin (Engl Ed). 2019 Jan;37(1):4-10. doi: 10.1016/j.eimc.2018.05.009. Epub 2018 Jun 12.
Over recent years we have witnessed an increase in the resistance of microorganisms to the available antimicrobials and a decrease in the number of new antimicrobials. Fosfomycin is a safe and cheap broad-spectrum antibiotic which has shown very promising results in combination therapy, mainly against gram-negative microorganisms. Little is known, however, about its clinical efficacy against gram-positive microorganisms.
We performed a retrospective review of all patients with severe gram-positive infections who received fosfomycin as part of their treatment from 2011 to 2017. We also performed in vitro time-kill assays to study the behaviour of fosfomycin with different antimicrobials against two strains of methicillin-resistant Staphylococcus aureus (MRSA) and two strains of methicillin-susceptible S. aureus (MSSA).
Seventy-five patients were treated with different fosfomycin combinations. Among them, 61 (81%) were successfully treated. Daptomycin plus fosfomycin was the most effective combination. Overall, the treatment with fosfomycin was safe, and side effects were minor. There was only one major side effect that resolved after discontinuation of therapy. Time-kill studies demonstrated increased activity of fosfomycin combinations, with daptomycin-fosfomycin being the most active combination against both MRSA and MSSA strains.
Our results suggest that antimicrobial combinations including fosfomycin are an alternative and effective approach for gram-positive infections.
近年来，我们目睹了微生物对现有抗菌药物的耐药性增加，以及新抗菌药物数量的减少。磷霉素是一种安全且廉价的广谱抗生素，在联合治疗中已显示出非常有前景的结果，主要针对革兰氏阴性微生物。然而，关于其对革兰氏阳性微生物的临床疗效知之甚少。
我们对2011年至2017年期间接受磷霉素作为治疗一部分的所有严重革兰氏阳性感染患者进行了回顾性研究。我们还进行了体外时间杀菌试验，以研究磷霉素与不同抗菌药物对两株耐甲氧西林金黄色葡萄球菌（MRSA）和两株甲氧西林敏感金黄色葡萄球菌（MSSA）的作用。
75例患者接受了不同的磷霉素联合治疗。其中，61例（81%）成功治愈。达托霉素加磷霉素是最有效的联合用药。总体而言，磷霉素治疗是安全的，副作用较小。只有一例严重副作用在停药后得到缓解。时间杀菌研究表明磷霉素联合用药的活性增加，达托霉素 - 磷霉素对MRSA和MSSA菌株都是最具活性的联合用药。
我们的结果表明，包括磷霉素在内的抗菌药物联合治疗是革兰氏阳性感染的一种替代且有效的方法。
