Fatih TEMOÇİN, Levent ŞENSOY, Tuba KURUOĞLU, Aynur ATİLLA, Esra TANYEL

Eski bir molekül, yeni bir ilaç; intravenöz Fosfomisinin klinik kullanımdaki yeri

Amaç: Çok ilaca dirençli bakterilerin sebep olduğu invaziv enfeksiyonların tedavisi zorlaşmaktadır. Yeni antibiyotik geliştirilmesindeki problemler, eski bir molekül olan ve geniş spektrumuna sahip olan fosfomisinin kullanımını gündeme getirmiştir. Bu çalışmada, intravenöz (İV) fosfomisinin klinik pratiğimizdeki gerçek yaşam verilerinin tartışılması amaçlanmıştır.Gereç ve yöntem: Çalışmaya Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi’nde, tedavisinde İV fosfomisin kullanılan hastalar dahil edilmiştir.Bulgular: Çalışmaya 18 (%50)’i erkek, 18 (%50)’i kadın toplam 36 hasta dahil edilmiştir. Hastaların yaş ortalaması 62,5±17,0 (18-90) saptanmıştır. İntravenöz fosfomisin kullanılan hastaların %34,2'si yoğun bakımda yatıyordu. İV fosfomisin kullanım endikasyonunun, 30 hastada (%83,3) üst üriner sistem enfeksiyonu, üç hastada (%8,3) alt solunum yolu enfeksiyonu, iki hastada (%5,5) kemik-eklem enfeksiyonu ve bir hastada (%2,7) ise kan dolaşımı enfeksiyonu olduğu saptanmıştır. Etken mikroorganizma %75 oranında Klebsiella pneumoniae, %19,4 oranında Providencia retgerii ve %5,6 oranında Escherichia coli olmuştur. Hastaların %72,7’sinde mikrobiyolojik kür oldu. İV fosfomisinin ortalama kullanım süresi 8,6±4,1 gün, ortalama günlük dozu ise 13,11±4,4 gr bulunmuştur. Hastaların %16,7’sinde hipernatremi geliştiği saptanmıştır. Çalışma hastalarının yarısında fosfomisin kombinasyon tedavisinde kullanıldığı görülmüştür. Kombinasyon tedavilerinde en sık %33,3 oranında bir karbapenem ile kombine edilmiştir. Monoterapi ve kombineterapi karşılaştırıldığında mikrobiyolojik yanıt, yan etki ve 14 günlük mortalite açısından gruplar arasında bir fark saptanmamıştır. Sonuç: İntravenöz fosfomisin, alt solunum yolu enfeksiyonları, osteomyelit, bakteriyel menenjit, üriner sistem enfeksiyonları ve sepsis gibi birçok endikasyonda kullanılmaktadır. Özellikle çok ilaca dirençli mikroorganizmaların neden olduğu enfeksiyonların tedavisinde kullanılan yeni bir alternatiftir. Bu çalışma sonucunda intravenöz fosfomisinin tedavi alternatifleri arasında iyi bir seçenek olduğunu düşünüyoruz.

Anahtar Kelimeler:

Fosfomisin, intravenöz, çok ilaca direnç

An old molecule, a new drug; the role of intravenous Fosfomycin in clinical use

Purpose: Treatment of invasive infections caused by multidrug-resistant bacteria is getting more difficult. Problems in the development of new antibiotics have led to the use of fosfomycin, an old molecule that has a broad spectrum. In this study, it was aimed to discuss the real life data of intravenous fosfomycin in our clinical practice.Materials and methods: Patients who were treated with IV fosfomycin in Ondokuz Mayıs University Medical Faculty Hospital were included in the study.Results: A total of 36 patients, 18 (50%) male and 18 (50%) female, were included in the study. The mean age of the patients was 62.5±17.0 (18-90) years. 34.2% of the patients who used intravenous fosfomycin were in the intensive care unit. IV fosfomycin use indication, 30 patients (83.3%) upper urinary tract infection, three patients (8.3%) lower respiratory tract infection, two patients (5.5%) bone-joint infection and one patient (2%, 7) was found to be a bloodstream infection. Indication of iv fosfomycin use was found to be upper urinary tract infection in 30 patients (83.3%), lower respiratory tract infection in three patients (8.3%), bone-joint infection in two patients (5.5%), bloodstream infection in one patient (2%). The causative microorganism was Klebsiella pneumoniae 75%, Providencia retgerii 19.4%, and Escherichia coli 5.6%. Microbiological cure occurred in 72.7% of the patients. The mean duration use of IV fosfomycin was 8.6±4.1 days, and the average daily dose was 13.11±4.4 g. It was found that 16.7% of the patients developed hypernatremia. It was observed that fosfomycin was used in combination therapy in half of the study patients. In combination therapies, it is most frequently combined with a 33.3% carbapenem. When monotherapy and combination therapy were compared, no difference was found between the groups in terms of microbiological response, side effects and 14-day mortality.Conclusion: Intravenous fosfomycin is used in many indications such as lower respiratory tract infections, osteomyelitis, bacterial meningitis, urinary tract infections, and sepsis. It is a new alternative especially used in the treatment of infections caused by multi-drug resistant microorganisms. As a result of this study, we think that intravenous fosfomycin is a good option among the treatment alternatives.

Keywords:

Fosfomycin, intravenous, multi drug resistance,

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