Table 1.
Summary of patients treated with fosfomycin-containing regimens from June 2018 to June 2023. M: male, F: female, GA: gestation age, CSF: cerebrospinal fluid, ADR: adverse drug reaction, HSV1: Herpes virus simplex 1, LGA: large for gestational age, HUS: head ultrasound, MRI: magnetic resonance imaging, EEG: electroencephalogram, AMK: amikacin, AMP: ampicillin, SLB: sulbactam, CTX: cefotaxime, CPT: ceftaroline, CAZ: ceftazidime, GEN: gentamicin, MEM: meropenem, and MZL: metronidazole.
| 0 Days, M | 21 Days, M | 64 Days, F | 2 Days, M | 5 Days, M | 0 Days, F | |
|---|---|---|---|---|---|---|
| Diagnosis | Brain abscesses | Meningitis with multiple subdural empyemas |
Meningitis | Meningitis with multiple subdural empyemas |
Meningitis with ventriculitis and subtentoral empyema | Brain abscess |
| GA | 27 + 2 weeks | 39 + 1 weeks | 26 + 6 weeks | 38 weeks | 39 + 3 weeks | 36 + 4 weeks |
| Birth weight | 830 g | 3038 g | 1020 g | 2730 g | 3664 g | 3930 g |
| Comorbidities | Patency of the Botallo’s duct | None | Membrane diseases hyaline, bronchopulmonary dysplasia |
None | None | Hypoxic–ischemic encephalopathy, LGA, gastro-esophageal reflux, pulmonary hypertension |
| Clinical presentation | Apnea, respiratory failure, metabolic acidosis | Poor feeding, drowsiness, fever, tachycardia, plaintive crying, hypotonia, seizures, respiratory failure | Respiratory distress and failure, poor feeding, hypotonic, hyporeactive | Pallor, hypotonia, polypnea, respiratory failure, fever, seizure | Fever, plaintive crying, irritability, polypnea, respiratory failure, seizure | Multiple organ failure, coma, seizure |
| CSF | None |
S. agalactiae HSV1 |
S. agalactiae | E. coli K1 | E. coli K1 | None |
| Other significant sample | Ocular, pharyngeal, rectal swabs, gastric juice | Blood | Blood, nasopharyngeal aspirate, pharyngeal, nasal, and rectal swabs | Blood, pharyngeal, ear, and nasal swabs, gastric juice, meconium | Blood, urine, nasopharyngeal aspirate, pharyngeal, ocular, and nasal swabs, meconium | None |
| Imaging | HUS | HUS, encephalon and brainstem MRI, EEG | HUS, encephalon and brainstem MRI, EEG | HUS, encephalon and brainstem MRI, EEG | HUS, encephalon and brainstem MRI, EEG | HUS, encephalon and brainstem MRI, EEG |
| Previous antibiotics | CAZ, GEN, AMP | AMP, GEN, CPT, MZL | AMK, CTX | AMP | AMP/SLB | CTX, AMP, MZL |
| Concomitant antibiotics | MEM, AMK | MEM | AMP, GEN | CTX | CTX, AMK | MEM |
| Days of fosfomycin | 7 | 12 | 5 | 21 | 5 | 28 |
| Dosage | 100 mg/kg/day q12h | 200 mg/kg/day q8h | 100 mg/kg/day q12h | 200 mg/kg/day q8h | 200 mg/kg/day q8h | 200 mg/kg/day q8h |
| ADR | None | None | None | None | None | None |
| Outcome | Death | Cortico-subcortical encephalomalacia with psychomotor delay and focal epilepsy | None | None | Death | Axis hypotonia and psychomotor delay |