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Burgos J, Hoyos-Mallecot Y, Ferre-Losa C, Arando M, Monforte A, Pumarola T, Los-Arcos I, Falcó V. Oral fosfomycin for treatment of acute bacterial prostatitis caused by multidrug-resistant Enterobacterales. Microbiol Spectr 2023; 11:e0213623. [PMID: 37737627 PMCID: PMC10580941 DOI: 10.1128/spectrum.02136-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/12/2023] [Indexed: 09/23/2023] Open
Abstract
To assess the feasibility of oral fosfomycin-tromethamine (FT) for the management of acute bacterial prostatitis (ABP) caused by multidrug-resistant (MDR) Enterobacterales. An observational study of adult patients diagnosed with ABP from Vall d'Hebron University Hospital (Barcelona, Spain), treated with oral FT. The primary outcome was clinical cure defined as symptom relief at the control visit, 2-4 weeks post-end of treatment. Secondary outcomes included microbiological cure, relapse, and adverse events related to the treatment. Eighteen patients with ABP caused by Enterobacterales (15 Escherichia coli and three Klebsiella pneumoniae) were included. Microorganisms were MDR bacteria [14 extended-spectrum beta-lactamase (ESBL) producers and two carbapenemase producing K. pneumoniae]. Patients received treatment with FT 3 g/48 hours during a median of 14 days (Q25-Q75, 12-17.75). Fifteen patients received a lead-in phase of intravenous suitable antimicrobial during a median of 7 days (Q25-Q75, 3.75-8). No patient had to stop treatment due to adverse events, and the only side effect reported in two patients was diarrhea. Clinical cure was achieved in all (18/18) patients and microbiological cure in 11/12 patients. After a median of follow-up of 5 months (Q25-Q75, 2-11), 2/18 patients relapsed with an orchitis and a new episode of ABP. FT is an attractive step-down therapy for ABP in patients with resistance or side effects to first-line drugs. The availability of oral treatment could reduce the use of the carbapenems, with a benefit in the quality of life of the patient, health costs, and an ecological impact. IMPORTANCE We present a brief but largest and interesting experience in which we use fosfomycin-tromethamine (FT) for the treatment of acute bacterial prostatitis (ABP) due to multiresistant bacteria. Our study provides new data that help to consider FT as a plausible alternative for treating ABP in patients with resistance or side effects to first-line drugs. The availability of an alternative oral treatment to avoid the use of the carbapenems could have important benefits in terms of quality of life of the patient, health costs, and an ecological impact.
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Affiliation(s)
- Joaquin Burgos
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron. Vall d'Hebron Research Institute (VHIR). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yannick Hoyos-Mallecot
- Microbiological Department, Hospital Universitari Vall d'Hebron. Vall d'Hebron Research Institute (VHIR). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carles Ferre-Losa
- Emergency Department, Hospital Universitari Vall d'Hebron. Vall d'Hebron Research Institute (VHIR). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maider Arando
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron. Vall d'Hebron Research Institute (VHIR). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Monforte
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron. Vall d'Hebron Research Institute (VHIR). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomas Pumarola
- Microbiological Department, Hospital Universitari Vall d'Hebron. Vall d'Hebron Research Institute (VHIR). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ibai Los-Arcos
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron. Vall d'Hebron Research Institute (VHIR). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicenç Falcó
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron. Vall d'Hebron Research Institute (VHIR). Universitat Autònoma de Barcelona, Barcelona, Spain
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Jacob J, Albert-Casado A, Del-Castillo JG, Llorens-Soriano P, Jiménez-Hernández S, Burillo-Putze G, Martín-Martínez A, Martín-Sánchez FJ, García-Lamberechts EJ, Piñera-Salmerón P, Alquézar-Arbé A, Ferre-Losa C, Juan-Gómez MÁ, Serrano-Lázaro L, Noceda-Bermejo J, Salido-Mota M, Fortuny-Bayarri MJ, González-Tejera M, Ferreras-Amez JM, Díaz-Fernández E, Quero-Motto E, Peiró-Gómez A, Martín-Mojarro E, Llopis-Roca F, Huerta-García A, Pedraza-García J, Meléndez-Cálix N, Brazó-Aznar JV, Cano-Cano MJ, Miró Ó. Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19. Rev Invest Clin 2022; 74:135-146. [PMID: 35240755 DOI: 10.24875/ric.22000021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. OBJECTIVES The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). METHODS Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. RESULTS We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom weredischarged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176 3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A totalof 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). CONCLUSION Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.
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Affiliation(s)
- Javier Jacob
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Arantxa Albert-Casado
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan G Del-Castillo
- Emergency Department, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Pere Llorens-Soriano
- Emergency Department, Hospital General de Alicante, University Miguel Hernández, Elche, Alicante, Spain
| | | | | | | | | | | | | | - Aitor Alquézar-Arbé
- Emergency Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carles Ferre-Losa
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María Á Juan-Gómez
- Emergency Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | - José Noceda-Bermejo
- Emergency Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Manuel Salido-Mota
- Emergency Department, Hospital Universitario Regional de Málaga, Málaga, Spain
| | | | | | - José M Ferreras-Amez
- Emergency Department, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Eva Quero-Motto
- Emergency Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | - Ferran Llopis-Roca
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Jorge Pedraza-García
- Emergency Department, Hospital Valle de los Pedroche de Pozoblanco, Córdoba, Spain
| | | | - José V Brazó-Aznar
- Emergency Department, Hospital Universitario de la Ribera, Valencia, Spain
| | | | - Óscar Miró
- Emergency Department, Hospital Clínic de Barcelona, Spain
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