<aside> 📢 Learn about antimicrobial stewardship teaching resources, staph aureus bacteremia complications, review articles on oral fosfomycin for complicated UTI, and learn how to write formative multiple-choice board questions.

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In This Issue

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Featured Educator

Untitled

IDChalkTalk of the Month

Learning Objectives

• List the most common sites of metastatic complications in S. aureus bacteremia
• Compare the clinical signs and symptoms that occur at different metastatic sites in complicated S. aureus bacteremia

Featured MedEd Article

This month, we ask the question: Is oral fosfomycin effective for the outpatient treatment of complicated urinary tract infections?

Written by: Rakhi Kohli, MD MS

The 2011 IDSA clinical practice guidelines endorse using single-dose oral fosfomycin as a first-line treatment for uncomplicated UTIs. However, fosfomycin has been increasingly used in a multiple-dose regimen for treatment of uncomplicated and complicated UTIs caused by multi-drug resistant organisms (MDRO). Oral fosfomycin use in this setting may prevent the need for parenteral antibiotics. This retrospective cohort study evaluated adult patients prescribed oral, multi-dose fosfomycin for complicated/recurrent UTI treatment between 1999 and 2018 at Kaiser Permanente Colorado. Patients with suspected pyelonephritis and those given fosfomycin for UTI prophylaxis were excluded. The primary outcome was clinical resolution of signs and symptoms of infection within 30 days. Of 171 multiple-dose fosfomycin treatment episodes, clinical resolution occurred in 115 (67.3%). The most common dose prescribed was one dose every 3 days (72.5%) and one dose every other day (19.9%) for a mean duration of 6.1 days. Bacteriologic resolution occurred in 48.7% of episodes with posttreatment cultures. Approximately half (51.5%) required antibiotic treatment after the initial fosfomycin course, which is similar to a baseline recurrence rate of about 54% noted in a prior study. Oral fosfomycin may be a useful treatment for UTI due to MDRO given that it is well-tolerated, has few drug-drug interactions, and is available in oral form. Further study is needed to examine the efficacy, safety, optimal dosing regimen and clinical use of fosfomycin for the treatment of UTI.

Derington CG, Benavides N, Delate T, et al. Multiple-Dose Oral Fosfomycin for Treatment of Complicated Urinary Tract Infections in the Outpatient Setting. Open Forum Infect Dis. 2020 Feb 7(2). PMID: 32123690.

This Month in FOAM

Are you up against resistance to appropriate antimicrobial use? Use these free online antimicrobial stewardship resources to educate your learners on best practices for antimicrobial treatment!

• Stewardship to the Core! CDC.gov is an essential starting point for learners at any level to become familiar with the Core Elements of Antimicrobial Stewardship in different healthcare settings and review current antimicrobial usage data throughout the US. Be sure to check back during #USAAW every year in November for the newest AS toolkit resources.
• Listen up! The Breakpoints podcast by @SIDPharm has several episodes devoted to stewardship, including the recent “Stewardship Struggles” segment with @ValerieVaughnMD, @JasonGNewland, and @The_Real_LDA joining host @ErinMcCreary to discuss using data to bolster AS efforts. Other fantastic stewardship-focused episodes: #66 Cephalosporin use in Penicillin Allergies, #41 AS in Immunocompromised Hosts, and #15 CDC Core Elements of AS.
• How long is long enough? Check out @BradSpellberg's Shorter Is Better tables for comprehensive and meticulously updated tables and reference lists on RCTs comparing longer vs shorter treatment.  @matthewmof31 also references this site in a great tweetorial covering the origins of the 7-day course,  the dogma of "full course" completion, and evidence on treatment duration for specific infection types.