The effect of administration of fosfomycin in the management of ventilator-associated pneumonia

• Main Authors: Shaimaa S Mohamed, Aya M Abdel Dayem, Mahmoud L Sakr, Ibrahim A Dwedar
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Egyptian Journal of Chest Disease and Tuberculosis
• Subjects: clinical pulmonary infection score; fosfomycin; ventilator-associated pneumonia
• Online Access: http://www.ejcdt.eg.net/article.asp?issn=0422-7638;year=2018;volume=67;issue=3;spage=318;epage=322;aulast=Mohamed

Introduction Recently, lack of new antibiotics, together with the rising resistance of antimicrobials against extensively drug-resistant strains of Pseudomonas aeruginosa, Acinetobacter baumannii, and carbapenemase-producing Klebsiella pneumoniae, had caused the restoration of old antibiotics like fosfomycin. Fosfomycin is considered a bactericidal antibiotic of the 1970s. It presents activity against multidrug resistant microorganisms. Patients and methods A randomized, controlled trial was designed between November 2015 and April 2016, including 40 patients diagnosed with ventilator-associated pneumonia (VAP). Patients were classified into two equally sized groups: group A (control group) comprised patients receiving only empirical systemic antibiotics and group B included patients receiving oral fosfomycin combined with empirical systemic antibiotics. Clinical pulmonary infection score (CPIS) and C-reactive protein (CRP) were used as predictors of improvement in both groups. Additionally, improvement and mortality rate were secondary endpoints of assessment. Results Age and sex among both groups did not show significant differences. The majority of patients in groups A and B were diagnosed as early-onset pneumonia 75 and 70%, respectively. K. pneumoniae was the most prevalent organism in cases of early as well as late-onset pneumonia (34.4 and 36%, respectively). CPIS and CRP were improved significantly in group B compared with baseline. Furthermore, CPIS and CRP had been declined significantly in group B compared with group A. Despite the significant improvement of CPIS and CRP in group B, it did not show significant lower mortality than in group A. Conclusion Fosfomycin is an effective antimicrobial agent in the treatment of VAP with low mortality rate. Furthermore, CPIS is a potential score used to evaluate the effectiveness of therapy in cases of VAP.