Department of Pediatric Infectious Disease, University of Health Sciences, Ankara Bilkent City Hospital, Ankara 06800, Turkey.
Department of Pediatric Infectious Disease, Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Ankara 06800, Turkey.
J Trop Pediatr. 2024 Aug 10;70(5). doi: 10.1093/tropej/fmae029.
Current data on fosfomycin usage in children are limited. We present data on the clinical use of intravenous (IV) fosfomycin in children. Hospitalized patients who received ≥3 days of IV fosfomycin between April 2021 and March 2023 were analyzed retrospectively. Forty-three episodes of infection in 39 patients were evaluated. The mean age of the patients was 5.35 (10 days to 17.5 years) years, and 54% were male. Infections were hospital-acquired in 79% of the episodes. Indications for fosfomycin were urinary tract infection (35%), bacteremia (32.6%), catheter-related bloodstream infection (16.3%), soft tissue infection (4.7%), sepsis (4.7%), surgical site infection (2.3%), burn infection (2.3%), and pneumonia (2.3%). Klebsiella pneumoniae was identified in 46.5% of the episodes, and a pan-drug or extensive drug resistance was detected in 75% of them. Carbapenem was used before fosfomycin at significantly higher rates in K. pneumoniae episodes (P = .006). Most (88.5%) patients received fosfomycin as a combination therapy. Culture negativity was achieved in 80% of episodes within a median treatment period of 3 (2-22) days, which was significantly shorter in K. pneumoniae episodes (P < .001). Treatment-related side effects were seen in 9.3% of the episodes. Side effects were significant after 3 weeks of treatment (P = .013). The unresponsivity rate to fosfomycin was 23.3%. Nine (21%) of the patients who were followed up in the intensive care units mainly died because of sepsis (56%). IV fosfomycin is an effective agent in treating severe pediatric infections caused by resistant microorganisms. Fosfomycin can be used in various indications and is generally safe for children.
目前关于磷霉素在儿童中的使用数据有限。我们报告了静脉注射（IV）磷霉素在儿童中的临床使用数据。回顾性分析了 2021 年 4 月至 2023 年 3 月期间接受≥3 天 IV 磷霉素治疗的住院患者。评估了 39 名患者的 43 个感染发作。患者的平均年龄为 5.35 岁（10 天至 17.5 岁），54%为男性。79%的感染为医院获得性感染。磷霉素的适应证为尿路感染（35%）、菌血症（32.6%）、导管相关血流感染（16.3%）、软组织感染（4.7%）、败血症（4.7%）、手术部位感染（2.3%）、烧伤感染（2.3%）和肺炎（2.3%）。46.5%的感染发作中分离出肺炎克雷伯菌，其中 75%的菌株存在泛耐药或广泛耐药。在肺炎克雷伯菌感染发作中，碳青霉烯类药物的使用明显高于磷霉素（P=0.006）。大多数（88.5%）患者接受了磷霉素联合治疗。在中位治疗期 3（2-22）天内，80%的感染发作达到了培养阴性，在肺炎克雷伯菌感染发作中这一比例显著更短（P<0.001）。9.3%的感染发作出现了与治疗相关的副作用。在治疗 3 周后，副作用显著（P=0.013）。磷霉素的无反应率为 23.3%。在重症监护病房随访的 9 名（21%）患者主要因败血症死亡（56%）。静脉注射磷霉素是治疗由耐药微生物引起的严重儿童感染的有效药物。磷霉素可用于多种适应证，对儿童一般安全。
