{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T07:01:12Z","timestamp":1780124472106,"version":"3.54.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006692","name":"Universit\u00e0 degli Studi di Torino","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006692","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Intravenous fosfomycin is a broad-spectrum, bactericidal antibiotic active against Gram-positive and Gram-negative bacteria, including multidrug-resistant (MDR) strains. Evidence regarding its use in paediatric patients, particularly as part of combination therapy, remains limited. This study aimed to evaluate the safety and clinical outcomes of intravenous fosfomycin-based combination therapy in children. We conducted a single-centre, retrospective study including paediatric patients aged 0\u201318\u00a0years who received IV fosfomycin at Regina Margherita Children\u2019s Hospital in Turin between July 2019 and April 2025. Patients with underlying comorbidities, immunosuppression, invasive devices, or prematurity were included. Fifty paediatric patients were enrolled, with a median age of 5.93\u00a0years and balanced sex distribution. Comorbidities were present in 80% of cases, and 56% had primary or acquired immunodeficiency. Fosfomycin was always used in combination therapy for confirmed bloodstream infections (54%), osteoarticular infections (12%), skin and soft tissue infections (8%), or other infections (24%). Microbiological identification was achieved in 90% of cases: 53.4%\n                    <jats:italic>Gram<\/jats:italic>\n                    -negative and 46.6%\n                    <jats:italic>Gram<\/jats:italic>\n                    -positive bacteria. Half of the isolated pathogens were MDR, including ESBL, CPE, MDR\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    , XDR and MDR\n                    <jats:italic>Gram<\/jats:italic>\n                    -positive bacteria. Five patients died, and therapeutic failure\u2014defined as death, relapse, or failure to achieve microbiological clearance\u2014occurred in 28% of cases. IV fosfomycin was well tolerated, and no adverse effects requiring treatment discontinuation were reported.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    :\u00a0In a cohort of vulnerable paediatric patients with severe underlying conditions and difficult-to-treat infections, IV fosfomycin-based combination therapy was well tolerated and associated with acceptable clinical outcomes. Its use should be considered a rescue therapy for infections resistant to standard treatment.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Fosfomycin is an old antibiotic that has been recently re-evaluated for intravenous use in severe infections causedby multidrug-resistant pathogens<\/jats:italic>\n                              .\u2022\n                              <jats:italic>It is increasingly used in combination regimens for diffi cult-to-treat infections, but paediatric evidence remainslimited<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>In a real-world cohort of high-risk children, fosfomycin-based combination therapy was associated with favourableclinical responses in infections due to MDR bacteria<\/jats:italic>\n                              .\u2022\n                              <jats:italic>Treatment was generally well tolerated, with limited clinically significant adverse events, even in a fragile andimmunocompromised paediatric population<\/jats:italic>\n                              .\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-06822-9","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T17:02:01Z","timestamp":1775840521000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fosfomycin combination therapy in high-risk paediatric patients with multidrug-resistant infections: a retrospective study"],"prefix":"10.1007","volume":"185","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8495-1844","authenticated-orcid":false,"given":"Marco","family":"Denina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Badiali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Vitale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Robasto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Funiciello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Silvestro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Pruccoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Garazzino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"6822_CR1","unstructured":"Gilbert DN et al (2025) The Sanford guide to antimicrobial therapy. 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Antibiotics 6:24","journal-title":"Antibiotics"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-06822-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-026-06822-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-026-06822-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T06:02:17Z","timestamp":1780120937000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-026-06822-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":27,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["6822"],"URL":"https:\/\/doi.org\/10.1007\/s00431-026-06822-9","relation":{},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]},"assertion":[{"value":"24 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with the principles of the Declaration of Helsinki and with Good Epidemiological Practice guidelines. Ethical approval was obtained from the\n                      Comitato Etico Territoriale (CET) Interaziendale AOU Citt\u00e0 della Salute e della Scienza di Torino\n                      .","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Informed consent was obtained from at least one legal representative (parent or legal guardian).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"254"}}