Bouiller Kévin, Zayet Souheil, Lalloz Paul-Emile, Potron Anaïs, Gendrin Vincent, Chirouze Catherine, Klopfenstein Timothée
Department of Infectious and Tropical Diseases, CHRU, 25000 Besançon, France.
Unité Mixte de Recherche Centre National de la Recherche Scientifique (UMR CNRS) 6249 Chrono-Environnement, University of Bourgogne Franche-Comté, 25000 Besançon, France.
Antibiotics (Basel). 2022 Feb 3;11(2):198. doi: 10.3390/antibiotics11020198.
Antimicrobial drugs to treat male urinary tract infection (UTI) with multidrug-resistant Enterobacterales are limited. We studied oral fosfomycin-trometamol (FT) in this situation. The objective was to assess the clinical cure rate in patients presenting UTIs treated with oral FT.
We conducted a single-center observational retrospective study from January 2017 to August 2018. The primary endpoint was clinical cure; and the secondary endpoints were incidence of recurrences, oral FT safety, and microbiological cure.
Sixteen male patients were included, presenting 21 UTI episodes. Fourteen patients (88%) have at least one underlying urologic disorder. We described 4 episodes of acute UTI and 17 episodes of chronic bacterial prostatitis (CBP). Sixteen out of twenty-one Enterobacterales were extended spectrum beta-lactamase (ESBL)-producers and all the patients presented a resistance to fluoroquinolones and trimethoprim/sulfamethoxazole. In acute UTI, the regimen was a daily dose of oral FT for a mean duration of 2.5 weeks (+/-7.0 days). Clinical and microbiological recovery was achieved in all patients, with no recurrence after 5.3 months follow-up on average (+/-10.4 days). In CBP, the regimen was one oral dose of fosfomycin every 24-48 h, for a mean duration of 5.5 weeks/UTI episodes (+/-15.3 days). Clinical and microbiological recovery was found in 16/17 cases. Seven of the twelve patients with CBP had relapsed and 3/12 had had a new episode of infection after an average follow-up of 5.8 months. Only 6/21 of patients presented minor or moderate adverse effects, such as digestive disorders.
FT could be an alternative option to carbapenems in the treatment of multidrug-resistant Enterobacterales infections for male UTIs.
用于治疗男性多重耐药肠杆菌科细菌引起的尿路感染（UTI）的抗菌药物有限。我们在此情况下研究了口服磷霉素氨丁三醇（FT）。目的是评估口服FT治疗UTI患者的临床治愈率。
我们进行了一项从2017年1月至2018年8月的单中心观察性回顾性研究。主要终点是临床治愈；次要终点是复发率、口服FT的安全性和微生物学治愈。
纳入了16名男性患者，共出现21次UTI发作。14名患者（88%）至少有一种潜在的泌尿系统疾病。我们描述了4次急性UTI发作和17次慢性细菌性前列腺炎（CBP）发作。21株肠杆菌科细菌中有16株是超广谱β-内酰胺酶（ESBL）产生菌，所有患者对氟喹诺酮类和甲氧苄啶/磺胺甲恶唑均耐药。在急性UTI中，治疗方案是每日口服FT，平均疗程为2.5周（±7.0天）。所有患者均实现了临床和微生物学康复，平均随访5.3个月（±10.4天）后无复发。在CBP中，治疗方案是每24 - 48小时口服一剂磷霉素，每次UTI发作的平均疗程为5.5周（±15.3天）。17例中有16例实现了临床和微生物学康复。12例CBP患者中有7例复发，平均随访5.8个月后，12例中有3例出现了新的感染发作。仅21例患者中有6例出现了轻微或中度不良反应，如消化系统紊乱。
在治疗男性UTI的多重耐药肠杆菌科细菌感染方面，FT可能是碳青霉烯类药物的替代选择。
