title: Fosfomycin for the Treatment of Cystitis in the Abdominal Solid Organ Transplant Population.
abstract: OBJECTIVE
  To evaluate the use of fosfomycin (FOS) at the single-dose regimen approved by the U.S. Food and Drug Administration as well as off-label multidose regimens for the treatment of cystitis after abdominal solid organ transplant (aSOT).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  Adult inpatients with history of aSOT receiving FOS between January 1, 2009, and April 30, 2015, for the treatment of cystitis.
  
  
  RESULTS
  Seventy-six courses of FOS were identified in 64 patients. Overall treatment success was 85.5%, with 11 failed treatment courses. Enterococcus was isolated in 59.3% of courses, of which 72.2% were vancomycin-resistant enterococci (VRE). Gram-negative organisms comprised a quarter of isolated bacteria, with most resistant to three or more antimicrobial classes. In the 11 failed treatment courses, 90% were targeted against enterococcus, of which 82% were VRE. Six of these failures (54%) were successfully retreated with uroselective therapy (FOS or nitrofurantoin). No significant difference in the success rate of single-dose versus multidose therapy was seen (80.6% vs 90%, p=0.33). Concomitant systemic antibiotics for other indications were present in 36.8% of courses, and they were significantly more frequent in the multidose group (67.5% vs 47.2%, p=0.04). However, multivariable logistic regression analysis found that after adjustment for broad-spectrum antibiotic use, no statistically significant difference in failure rates was found between the two regimens (p=0.42).
  
  
  CONCLUSIONS
  FOS appears to be successful in the treatment of cystitis in aSOT recipients. Multidose therapy did not significantly improve success over a single-dose regimen. Further prospective studies are needed to elucidate the true efficacy of FOS in the aSOT population.
authors.affiliation: University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Loethen
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Luiza
authors.initials: L
authors.lastname: Kerstenetzky
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Jillian L
authors.initials: JL
authors.lastname: Descourouez
authors.affiliation: Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Glen E
authors.initials: GE
authors.lastname: Leverson
authors.affiliation: Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Jeannina A
authors.initials: JA
authors.lastname: Smith
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Jorgenson
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003556:Cystitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D066027:Transplant Recipients; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005578:Fosfomycin
keywords: cystitis; enterococcus; fosfomycin; solid organ transplant