fosfomycin and Kidney-Failure--Chronic

Sphingomonas paucimobilis is an aerobic, oxidase-positive, yellow-pigmented, non-fermentative, Gram-negative opportunistic pathogen that rarely causes infections in humans. It is commonly found in nosocomial environments and, despite its low clinical virulence, it can be responsible for several different infections especially among patients with underlying disease. Here we describe a clinical case of a 46-year-old male paraplegic patient with a history of neurogenic bladder due to insulin-dependent diabetes mellitus and renal failure who was admitted to the urology clinic of a university hospital in Kirsehir, Turkey, with the complaints of urinary tract infection (UTI) including fever, chills, dysuria, abdominal and back pain. The urine culture was positive for Sphingomonas paucimobilis identified by the Vitek-2 system and the patient was successfully treated with oral co-trimoxazole 800/160 mg twice a day for ten days associated to cefixime and fosfomycin. A literature review of UTIs associated to Sphingomonas paucimobilis is reported as well.

Topics: Anti-Bacterial Agents; Cefixime; Community-Acquired Infections; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Disease Susceptibility; Drug Therapy, Combination; Fosfomycin; Gram-Negative Bacterial Infections; Humans; Kidney Failure, Chronic; Male; Middle Aged; Opportunistic Infections; Paraplegia; Recurrence; Sphingomonas; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey; Urinary Bladder, Neurogenic; Urinary Tract Infections

Kinetics of fosfomycin were investigated in six patients undergoing continuous ambulatory peritoneal dialysis. Each subject received both an i.v. and an i.p. 1 g dose of fosfomycin with a one week washout between doses. Fosfomycin was assayed by a microbiological diffusion technique. After intravenous injection the fosfomycin serum kinetic parameters were as followed: elimination half-life (t1/2 beta) 38.4 +/- 8.7 h; volume of distribution 0.32 +/- 0.02 l/kg; total plasma clearance 7.0 +/- 1.4 ml/min and peritoneal clearance 3.2 +/- 0.2 ml/min. Dialyzate fosfomycin concentrations reached a maximum mean value of 32.2 +/- 2.8 micrograms/ml at 4 h post-injection and fosfomycin was detectable in dialyzate samples for up to 72 hours post-dosing. After intraperitoneal instillation, fosfomycin appeared in the serum rapidly and the mean peak plasma concentration was 36.2 +/- 2.8 micrograms/ml at the 4th h. The absorption rate (ka) was 0.580 +/- 0.039 h-1 and the absorption of fosfomycin from peritoneal space was 68.4 +/- 6.0%. These data suggest a bidirectional exchange through the peritoneal membrane. Intraperitoneal administration of 1 g either 48 h apart for anephric patients or 36 h apart for patients with residual renal function may achieve therapeutic serum concentrations.

Topics: Female; Fosfomycin; Humans; Infusions, Parenteral; Injections, Intravenous; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Time Factors

99mTc-Phosphomycin, a new radiopharmaceutical for kidney visualization, was used for animal experiments and tests of 171 patients. The results confirmed the usefulness of this product. The ease and yield of the labelling procedure, the low cost of the product, the excellent quality of the images and the functional information obtained showed that the use of 99mTc-phosphomycin as a radiopharmaceutical for kidney visualization has many advantages.

Topics: Adolescent; Adult; Aged; Animals; Anti-Bacterial Agents; Aprotinin; Ascorbic Acid; Chromatography, Paper; Female; Fosfomycin; Humans; Hypertension, Renal; Intestines; Kidney; Kidney Failure, Chronic; Kinetics; Liver; Male; Mice; Middle Aged; Organotechnetium Compounds; Rabbits; Radionuclide Imaging; Technetium; Time Factors

The pharmacokinetics of fosfomycin, an original antimicrobial agent, were investigated in 11 voluntary hemodialyzed patients. Fosfomycin, 2 g, was administered intravenously, 15 minutes before hemodialysis began in group 1 (6 patients), and just after hemodialysis in group 2 (6 patients). Blood samples were collected during 8 hours (group 1) and during 44 hours (group 2). Antibiotic concentrations were determined microbiologically. In group 1, half-life was 4.2 +/- 0.27 hours, total clearance 65.1 +/- 7.1 ml/mn and clearance by hemodialyzer 103 +/- 10 ml/mn. In group 2 plasma levels were 60 mg/l at the 44th hour and half-life was 48.8 +/- 17.5 hours. These results suggest that fosfomycin is actively eliminated by the hemodialyzer in group 1, and largely retained between two dialysis sessions in group 2. As for therapy, intravenous administration of 2 g after dialysis and further administration after each succeeding session are proposed.

Topics: Adult; Aged; Anti-Bacterial Agents; Female; Fosfomycin; Half-Life; Humans; Injections, Intravenous; Kidney Failure, Chronic; Kinetics; Male; Middle Aged; Renal Dialysis

Topics: Anti-Bacterial Agents; Drug Tolerance; Fosfomycin; Humans; Kidney Failure, Chronic; Pseudomonas; Sepsis; Serratia

After the parenteral injection of 1 g sodium salt of fosfomycin the serum levels of the antibiotic are detected in a series of eight adult patients with different degrees of chronic renal insufficiencies four of them submitted to periodical dialysis. The results obtained reveal that the levels as well as the time of elimination of fosfomycin maintain an obvious relation to the degree of renal insufficiency in the patients.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Fosfomycin; Humans; Injections, Intramuscular; Kidney Failure, Chronic; Middle Aged; Renal Dialysis; Time Factors

The sensitivity to fosfomycin which is found in organisms that are frequently found in urinary infections and the lack of toxicity of this antibiotic were the reasons for which we tested fosfomycin on patients who were subjected to periodic hemodialysis. We were interested in studying (1) if fosfomycin was dialyzable, and (2) its therapeutic pattern in these patients. We selected a group of 27 patients from our programme of periodic hemodialysis who spend 18 h each week in three sessions with an RSP Travenol artificial kidney, using Ultra Flo II as the dialytic unit. They were all free of infection and had not received any antibiotics for 40 days before the test was carried out. They were administered 1 or 2 g of fosfomycin by the intravenous route at the time of beginning the dialysis. Blood samples and samples from the dialytic bath were taken before administering the fosfomycin, and 1/2, 3 and 6 hours after administering it. Our results show that fosfomycin is 70-80% dialyzed by the membranes of the artificial kidney and that during the hemodialysis, given the clearance which the dialyzing membrane makes of the antibiotic, the usual doses of fosfomycin should not be altered. No side effects were observed in any of the patients.

Topics: Anti-Bacterial Agents; Fosfomycin; Humans; Injections, Intravenous; Kidney Failure, Chronic; Renal Dialysis; Time Factors; Urinary Tract Infections