Fosfomycin Tromethamine

The infection rates following transrectal ultrasound-guided (TRUS) prostate biopsy range from 1-5%, mostly caused by Escherichia coli. We investigated an abnormal increase in Klebsiella pneumoniae prostatitis rate following TRUS prostate biopsy in a urological surgery center.

The outbreak occurred in a 217-bed private hospital performing TRUS prostate biopsies. After an antibiotic prophylaxis (single 3 g dose of fosfomycin-trometamol 2 hours before the procedure), each biopsy was placed on a pre-impregnated sponge and then transferred to a plastic cassette for pathological analysis. The outbreak investigation relied on a retrospective analysis of cases defined as the occurrence of a urinary or systemic infection caused by K. pneumoniae within 7 days following a TRUS prostate biopsy, including a review of procedures and microbiological analysis.

Between January 1 and March 31, 2024, 13/49 (27%) patients who underwent TRUS prostate biopsy developed clinical symptoms of prostatitis requiring hospitalization. The incidence rate was 20% (5/25, three with E. coli) from January 3 to February 20, 2024 and increased to 33% (8/24, seven with K. pneumoniae) from February 21 to March 31, 2024. During the investigation, K. pneumoniae strains isolated from clinical samples and moistened sponges were genotypically similar, confirming the latter as the source of infection. The pack of sponges in use was discarded, with sterilization of sponges and trays before their use. No other case of K. pneumoniae prostatitis was identified following these measures from April to December 2024.

This investigation underlines the critical need for evaluation of practices around the preparation of sponges and cassettes in contact with the puncture needle when performing TRUS prostate biopsy.

Urinary tract infection (UTI) is the second most common type of infection in the human body. It is one of the most prevalent conditions in medical practice, with approximately 150 million cases occurring globally each year. Approximately 50% of women will experience at least one episode of UTI during their lifetime, and between 20 and 40% will have recurrent episodes. The discovery of a broad-spectrum antibiotic, fosfomycin tromethamine, occurred in Spain in 1969 and is prominently used in the management of uncomplicated UTIs. As a phosphonic acid derivative, fosfomycin acts by disrupting bacterial cell wall synthesis by inhibiting the enzyme MurA, demonstrating effective activity against a wide variety of gram-negative and gram-positive pathogens, comprising multidrug-resistant strains such as Escherichia coli and Klebsiella pneumoniae. Fosfomycin is not metabolized and is predominantly excreted unchanged in the urine through glomerular filtration. Mean peak urinary concentrations of fosfomycin ranging from 1053 to 4415 mg/L occur within 4 hours of administration of a single oral dose of fosfomycin tromethamine correspondent to fosfomycin 3 gm. Urinary concentrations >128 mg/L, which are adequate to inhibit most urinary pathogens, are maintained for 24-48 hours following a single oral dose of fosfomycin tromethamine. This makes it particularly advantageous for uncomplicated UTIs, where it offers a convenient and effective single-dose treatment option. Clinical trials and observational studies have consistently shown high cure rates and patient compliance, attributing this to its minimal side effects and broad-spectrum efficacy. A single oral dose of fosfomycin tromethamine, equivalent to 3 gm of fosfomycin, is indicated for treating acute uncomplicated lower UTIs in adults. It is classified as pregnancy category B. Various clinical guidelines, such as the Infectious Diseases Society of America (IDSA), European Association of Urology (EAU), and National Institute for Health and Care Excellence (NICE), also recommend fosfomycin tromethamine for the treatment of UTI. In conclusion, fosfomycin tromethamine remains a robust and indispensable antibiotic in the management of uncomplicated UTIs, with a distinct pharmacological profile that ensures both efficacy and safety, and patient compliance due to its single-dose regimen.