{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:04:05Z","timestamp":1792785845494,"version":"4.5.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"National Institute of Infectious Diseases","award":["2022-ER2208-00"],"award-info":[{"award-number":["2022-ER2208-00"]}],"id":[{"id":"https:\/\/ror.org\/001ggbx22","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute of Infectious Diseases","award":["2022-NI-017-00"],"award-info":[{"award-number":["2022-NI-017-00"]}],"id":[{"id":"https:\/\/ror.org\/001ggbx22","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Extended-spectrum \u03b2-lactamase (ESBL)\u2013producing Enterobacterales are an increasing cause of complicated urinary tract infections (UTIs). Reliance on carbapenems to treat these infections accelerates resistance, underscoring the urgent need for effective oral transition options to preserve last-line agents and lessen healthcare burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter, open-label, randomized, noninferiority trial at four tertiary hospitals in South Korea (November 2022\u2013June 2025). Adults hospitalized with complicated UTIs due to ESBL-producing Enterobacterales who improved after 3\u20137 days of intravenous antibiotics were randomized (1:1) to either continue intravenous carbapenem or \u03b2-lactam\/\u03b2-lactamase inhibitor therapy or switch to oral fosfomycin trometamol (3 g once daily). The primary outcome was clinical cure, defined as resolution of urinary tract infection\u2013related symptoms and signs within 4 days after completion of treatment. Secondary outcomes included microbiological cure, readmission, adverse events, and 30-day recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 344 screened patients, 299 were randomized (152 oral fosfomycin; 147 intravenous therapy). Clinical cure occurred in 92.8% of the oral fosfomycin group and 95.2% of the intravenous group (risk difference, \u22122.47%; 95% CI \u22127.84 to 2.89), confirming noninferiority. Microbiological cure was similarly high in both groups: urine (98.0% vs 96.6%) and blood (97.3% vs 97.5%). Safety profiles and 30-day outcomes were also comparable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Oral fosfomycin was noninferior to continued intravenous therapy when used as oral transition therapy for complicated UTIs caused by ESBL-producing Enterobacterales. These findings provide evidence to support oral fosfomycin transition as a carbapenem-sparing antibiotic stewardship strategy for patients with complicated UTIs caused by ESBL-producing Enterobacterales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trials Registration<\/jats:title>\n                    <jats:p>KCT0007669.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciag345","type":"journal-article","created":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T11:36:54Z","timestamp":1780227414000},"page":"364-372","source":"Crossref","is-referenced-by-count":4,"title":["Fosfomycin as Oral Transition Therapy Versus Continued Intravenous \u03b2-Lactams for Complicated Urinary Tract Infections Caused by Extended-Spectrum \u03b2-Lactamase\u2013Producing\n                    <i>Enterobacterales<\/i>\n                    : A Multicenter, Open-Label, Randomized Controlled Trial"],"prefix":"10.1093","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2806-1863","authenticated-orcid":false,"given":"Jun-Won","family":"Seo","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Chosun University , Gwangju Metropolitan City ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1372-2286","authenticated-orcid":false,"given":"Da Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Chosun University , Gwangju Metropolitan City ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8186-020X","authenticated-orcid":false,"given":"Youngmin","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Chosun University , Gwangju Metropolitan City ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5929-1215","authenticated-orcid":false,"given":"Young Sang","family":"Lyu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Chosun University , Gwangju Metropolitan City ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2506-2673","authenticated-orcid":false,"given":"Yong Sub","family":"Na","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Chosun University , Gwangju Metropolitan City ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5746-2175","authenticated-orcid":false,"given":"Do Sik","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Chosun University , Gwangju Metropolitan City ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4219-0127","authenticated-orcid":false,"given":"Na Ra","family":"Yun","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Chosun University , Gwangju Metropolitan City ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4577-200X","authenticated-orcid":false,"given":"Min Seok","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Urology, Chosun University College of Medicine , Gwangju Metropolitan City ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Han","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Ewha Womans University, Mokdong Hospital , Seoul ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0860-4303","authenticated-orcid":false,"given":"Sang Woon","family":"Bae","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Yeungnam University Medical Center , Daegu Metropolitan City ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3219-8368","authenticated-orcid":false,"given":"Jian","family":"Hur","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Yeungnam University Medical Center , Daegu Metropolitan City ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0250-212X","authenticated-orcid":false,"given":"Min Hyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine , Gyeonggi-do ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4640-9525","authenticated-orcid":false,"given":"Yoon Soo","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine , Gyeonggi-do ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0190-703X","authenticated-orcid":false,"given":"Heejung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Yongin Severance Hospital, Yonsei University College of Medicine , Gyeonggi-do ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3819-9057","authenticated-orcid":false,"given":"Hyungdon","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon Sacred Heart Hospital , Gangwon-do ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9185-8081","authenticated-orcid":false,"given":"Younggwon","family":"On","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases, Korea National Institute of Health, Korea Disease Control and Prevention Agency , Cheongju, Chungchongbuk-do ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8550-9150","authenticated-orcid":false,"given":"Seok Hyeon","family":"Na","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases, Korea National Institute of Health, Korea Disease Control and Prevention Agency , Cheongju, Chungchongbuk-do ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Sik","family":"Yoo","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases, Korea National Institute of Health, Korea Disease Control and Prevention Agency , Cheongju, Chungchongbuk-do ,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3407-8493","authenticated-orcid":false,"given":"Hee-Chang","family":"Jang","sequence":"additional","affiliation":[{"name":"National Institute of Infectious Diseases, Korea National Institute of Health, Korea Disease Control and Prevention Agency , Cheongju, Chungchongbuk-do ,","place":["Republic of 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