Factors Affecting Mortality in Resistant Gram-negative Infections Developed in Patients Followed in the Intensive Care Unit and Treated with Fosfomycin

Abstract

Objective: Our study aimed to investigate the survival rates and factors affecting mortality in Gram-negative infections treated with intravenous (IV) fosfomycin. Materials and Methods:Patients with microbiologically proven infections in our hospital's intensive care unit (ICU) and who were treated with IV fosfomycin between 2019 and 2021 were included in our study. Demographic characteristics of the patients and initiation of treatment sequential organ failure assessment (SOFA) score, indications for fosfomycin usage, microbiological and clinical response to treatment, and outcome status of the patients were screened. Results:Of the 96 patients included in the study, 58% (n=56) were male. The survival rate of the patients who received fosfomycin treatment was 27% (n=26). There was no statistically significant difference between the patient's age, gender, and comorbidities according to the outcome. The disease in which fosfomycin treatment was used the most was pneumonia (87%), and the most treated bacteria were Klebsiella pneumoniae (84%). No statistically significant correlation was found between the outcome status of the patients and the site of infection. However, there was a statistically significant relationship regarding initiation of the treatment SOFA score, type of concomitant antibiotic, clinical response after 72 h, microbiological response at the end of treatment, development of acute renal failure, and development of thrombocytopenia. Conclusion:Care should be taken when administering combined treatments with fosfomycin to patients followed in the ICU and infected with multi-drug resistant Gram-negative infections. Treatment options are limited in this patient group, which has high mortality rates despite treatment. Our study investigated the parameters that can be used to predict treatment response to fosfomycin. It was thought that it would be beneficial to start the treatment according to these parameters when treating this patient group.