{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T12:15:51Z","timestamp":1762258551103,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T00:00:00Z","timestamp":1762041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Intra-abdominal infection (IAI) is a challenging condition that needs both medical and surgical treatment and it is still associated with high morbidity and mortality rates. Fosfomycin is approved for use in combination therapy for IAIs. The aim of this study was to evaluate the impact of intravenous fosfomycin addition in a combination regimen for IAI treatment in an intensive care setting. Methods: We performed a retrospective, observational, monocentric study. We enrolled patients admitted to the ICU with IAIs from April 2022 to June 2024. Patients were divided into two groups: Group A, standard treatment; and Group B, combination therapy including fosfomycin. Primary endpoints were clinical response at 7 days and in-hospital mortality; moreover, a risk factor analysis for mortality was also performed. Results: In total, 104 patients were enrolled, 85 in Group A, and 19 in Group B. Groups were homogenous in regard to demographics, but clinical condition was slightly worst in Group B. Source control &lt; 24 h was performed in 69.6% and 33.3% cases in Group A and Group B, respectively (p = 0.017). Clinical response on day 7 (81.2% vs. 73.7%, p = 0.675) and in-hospital mortality (27.1% vs. 47.2%, p = 0.145) were comparable. Univariate and multivariate analysis highlighted Charlson Comorbidity Index (CCI) (p = 0.04) and septic shock (p = 0.029) as risk factors, and effective empirical therapy (p = 0.04) as the protective factor; fosfomycin was not directly associated with outcome improvement. Conclusions: The outcome was comparable between groups; clinicians preferred to administer a combination regimen including fosfomycin in patients with statistically significant greater severity of illness and without early source control.<\/jats:p>","DOI":"10.3390\/antibiotics14111104","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:15:14Z","timestamp":1762175714000},"page":"1104","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fosfomycin in Complicated Intra-Abdominal Infections in an Intensive Care Setting: Does It Improve the Outcome? A Retrospective Observational Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Giovanni","family":"Genga","sequence":"first","affiliation":[{"name":"Infectious Diseases Clinica, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy"},{"name":"Infectious Diseases Unit, Santa Maria Hospital, University of Perugia, 06123 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Ragni","sequence":"additional","affiliation":[{"name":"Infectious Diseases Clinica, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Carolina","family":"Benvenuto","sequence":"additional","affiliation":[{"name":"Infectious Diseases Clinica, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Svizzeretto","sequence":"additional","affiliation":[{"name":"Infectious Diseases Clinica, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy"},{"name":"Infectious Diseases Unit, Santa Maria Hospital, University of Perugia, 06123 Terni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Tommasi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Clinica, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8774-4843","authenticated-orcid":false,"given":"Giuseppe Vittorio Luigi","family":"De Socio","sequence":"additional","affiliation":[{"name":"Infectious Diseases Clinica, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Francisci","sequence":"additional","affiliation":[{"name":"Infectious Diseases Clinica, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0355-2885","authenticated-orcid":false,"given":"Carlo","family":"Pallotto","sequence":"additional","affiliation":[{"name":"Infectious Diseases Clinica, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,2]]},"reference":[{"key":"ref_1","unstructured":"CDC\/NHSN (2025, April 01). Surveillance Definition for Specific Types of Infections, Available online: https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/17pscnosinfdef_current.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1749-7922-5-9","article-title":"A focus on intra-abdominal infections","volume":"5","author":"Sartelli","year":"2010","journal-title":"World J. Emerg. Surg."},{"key":"ref_3","unstructured":"Antimicrobial Resistance Collaborators (2022). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet, 399, 629\u2013655."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s13017-024-00551-w","article-title":"Management of intra-abdominal infections: Recommendations by the Italian council for the optimization of antimicrobial use","volume":"19","author":"Sartelli","year":"2024","journal-title":"World J. Emerg. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.ejim.2024.07.019","article-title":"Intra-abdominal infection and sepsis in immunocompromised intensive care unit patients: Disease expression, microbial aetiology, and clinical outcomes","volume":"129","author":"Paiva","year":"2024","journal-title":"Eur. J. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S81","DOI":"10.1093\/cid\/ciae346","article-title":"2024 Clinical practice guideline update by the Infectious Diseases Society of America on complicated intra-abdominal infections: Risk assessment, diagnostic imaging, and microbiological evaluation in adults, children, and pregnant people","volume":"79","author":"Bonomo","year":"2024","journal-title":"Clin. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1126\/science.166.3901.122","article-title":"Phosphonomycin, a new antibiotic produced by strains of streptomyces","volume":"166","author":"Hendlin","year":"1969","journal-title":"Science"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"107164","DOI":"10.1016\/j.ijantimicag.2024.107134","article-title":"Intravenous fosfomycin in combination regimens as a treatment option for difficult-to-treat infections due to multi-drug-resistant Gram-negative organisms: A real-life experience","volume":"63","author":"Meschiari","year":"2024","journal-title":"Int. J. Antimicrob. Agents."},{"key":"ref_9","first-page":"19","article-title":"Deciphering pharmacokinetics and pharmacodynamics of fosfomycin","volume":"32","year":"2019","journal-title":"Rev. Esp. Quimioter."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"525","DOI":"10.2147\/TCRM.S199119","article-title":"Fosfomycin: The characteristics, activity, and use in critical care","volume":"15","author":"Hashemian","year":"2019","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13017-024-00552-9","article-title":"Intra-abdominal infections survival guide: A position statement by the Global Alliance for Infections in Surgery","volume":"19","author":"Sartelli","year":"2024","journal-title":"World J. Emerg. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"107190","DOI":"10.1016\/j.ijantimicag.2024.107190","article-title":"Intravenous fosfomycin for treatment of severe infections caused by carbapenem-resistant Acinetobacter baumannii: A multi-centre clinical experience","volume":"64","author":"Russo","year":"2024","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Nussbaumer-proll, A., Obermuller, M., Weiss-Tessbach, M., Eberl, S., Zeitlinger, M., Matiba, B., Mayer, C., and Kussmann, M. (2025). Synergistic activity of fosfomycin and flucloxacillin against methicillin-susceptible and methicillin-resistant Staphylococcus aureus: In vitro and in vivo assessment. Med. Microbiol. Immunol., 214.","DOI":"10.1007\/s00430-025-00841-3"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"dlaf087","DOI":"10.1093\/jacamr\/dlaf087","article-title":"Shoulder prosthetic joint infection due to Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii treated with ciprofloxacin, minocycline and continuous infusion fosfomycin as OPAT regimen: A case report","volume":"7","author":"Pallotto","year":"2025","journal-title":"JAC Antimicrob Resist."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1007\/s00134-022-06883-y","article-title":"Poor timing and failure of source control are risk factors for mortality in critically ill patients with secondary peritonitis","volume":"48","author":"Antonelli","year":"2022","journal-title":"Intensive Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Bova, R., Griggio, G., Vallicelli, C., Santandrea, G., Coccolini, F., Ansaloni, L., Sartelli, M., Agnoletti, V., Bravi, F., and Catena, F. (2024). Source control and antibiotics in intra-abdominal infections. Antibiotics, 13.","DOI":"10.3390\/antibiotics13080776"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1055\/s-0041-1741053","article-title":"Intra-abdominal Infections","volume":"43","author":"Napolitano","year":"2022","journal-title":"Semin. Respir. Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.jcrc.2018.12.001","article-title":"Risk factors for mortality and cost implications of complicated intra-abdominal infections in critically ill patients","volume":"50","author":"Carelli","year":"2019","journal-title":"J. Crit. Care"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Luo, X., Li, L., Ou, S., Zeng, Z., and Chen, Z. (2022). Risk factors for mortality in abdominal infection patients in ICU: A retrospective study from 2011 to 2018. Front. Med., 9.","DOI":"10.3389\/fmed.2022.839284"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1089\/sur.2014.166","article-title":"Inadequate source control and inappropriate antibiotics are key determinants of mortality in patients with intra-abdominal sepsis and associated bacteremia","volume":"16","author":"Tellor","year":"2015","journal-title":"Surg. Infect."},{"key":"ref_21","unstructured":"Trautner, B.W., Cortes-Penfield, N.W., Gupta, K., Hirsch, E.B., Horstmen, M., Moran, G.J., Colgan, R., O\u2019Horo, J.C., Ashraf, M.S., and Connolly, S. (2025, August 01). Clinical Practice Guideline by Infectious Diseases Society of America (IDSA): 2025 Guideline on Management and Treatment of Complicated Urinary Tract Infections. Available online: https:\/\/www.idsociety.org\/practice-guideline\/complicated-urinary-tract-infections\/."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e2138691","DOI":"10.1001\/jamanetworkopen.2021.38691","article-title":"The role of intravenous fosfomycin: Finding our way out of Dante\u2019s forest dark","volume":"5","author":"Tamma","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s40121-015-0092-8","article-title":"Adverse events associated with fosfomycin use: Review of the literature and analyses of the FDA adverse event reporting system database","volume":"4","author":"Iarikov","year":"2015","journal-title":"Infect. Dis. Ther."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/11\/1104\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T12:00:36Z","timestamp":1762257636000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/11\/1104"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,2]]},"references-count":23,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["antibiotics14111104"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14111104","relation":{},"ISSN":["2079-6382"],"issn-type":[{"type":"electronic","value":"2079-6382"}],"subject":[],"published":{"date-parts":[[2025,11,2]]}}}