{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:59Z","timestamp":1787028659071,"version":"build-2736575974"},"reference-count":23,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Fosfomycin is an old antibiotic that has recently gained attention owing to its preserved activity against multidrug-resistant (MDR) bacteria. Data on its use in real life are limited. Thus, we evaluated the efficacy and safety of fosfomycin disodium in the context of our hospital clinical practice. Methods: Single-center, retrospective, observational study on 56 patients who received fosfomycin disodium from September 2016 to July 2023, focusing on clinical and microbiological outcomes and adverse events. Results: Included in this study were 56 patients. Fosfomycin disodium was administered for a median duration of 10 days [5\u201313.5] and was always used in combination with other antibiotics, more frequently with meropenem (16 cases, 28.6%) and colistin (11 cases, 19.6%). It was mostly used for treating pneumonia (41%), followed by bloodstream infections (19.6%), urinary tract infections (16.1%), bone infections (16.1%), and surgical site infections (7.1%). The most common isolated pathogen was Pseudomonas aeruginosa (17%), and polymicrobial infections were detected in 18 patients (32%). Among the isolated bacteria, 36 (44.4%) were MDR. The complete resolution, defined as the disappearance of symptoms, eradication of the causative microorganism, and decrease in CRP levels, was achieved in 39% of cases. During treatment, we observed electrolyte imbalances, in particular a decrease in serum potassium (0.6 mEq\/L [0.3\u20131.1]), calcium (0.7 mEq\/L [0.3\u20131.1]) and magnesium levels (0.3 mg\/dL [0.20\u20130.48]), and an increase in serum sodium levels (4 mEq\/dL [2\u20137]). Changes in potassium and sodium levels were more pronounced in patients with prior kidney dysfunction and heart failure, respectively, and in patients receiving fosfomycin diluted with saline compared with 5% glucose solution (p = 0.04). Conclusions: Fosfomycin is effective in treating complicated infections in comorbid patients when combined with other antimicrobials. During treatment, major electrolyte imbalances occur that require careful monitoring and correction, especially in patients with prior kidney disease.<\/jats:p>","DOI":"10.3390\/jcm14124386","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T03:05:27Z","timestamp":1750388727000},"page":"4386","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Efficacy and Safety of Fosfomycin Disodium in Patients with Bacterial Infections: A Single-Center, Real-Life Clinical Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1184-3428","authenticated-orcid":false,"given":"Fabio","family":"Luciano","sequence":"first","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3205-4292","authenticated-orcid":false,"given":"Lorenzo","family":"Bertolino","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8556-9180","authenticated-orcid":false,"given":"Fabian","family":"Patauner","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9060-7943","authenticated-orcid":false,"given":"Filomena","family":"Boccia","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine and Transplants, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Gallo","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3123-2241","authenticated-orcid":false,"given":"Pino","family":"Sommese","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Maria Carolina","family":"Peluso","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oriana","family":"Infante","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6175-1030","authenticated-orcid":false,"given":"Silvia","family":"Mercadante","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augusto","family":"Delle Femine","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arta","family":"Karruli","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Andini","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine and Transplants, AORN Ospedali dei Colli-Monaldi Hospital, Piazzale E. Ruggieri, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Zampino","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5381-3537","authenticated-orcid":false,"given":"Emanuele","family":"Durante-Mangoni","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences and Department of Precision Medicine, University of Campania \u2018L. Vanvitelli\u2019, Via De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Karruli, A., Andini, R., Corcione, A., and Durante-Mangoni, E. (2019). Prevention and control of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: Need for a multimodal approach. Ann. Transl. Med., 7.","DOI":"10.21037\/atm.2019.09.130"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Giurazza, R., Mazza, M.C., Andini, R., Sansone, P., Pace, M.C., and Durante-Mangoni, E. (2021). Emerging Treatment Options for Multi-Drug-Resistant Bacterial Infections. Life, 11.","DOI":"10.3390\/life11060519"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1093\/cid\/ciab696","article-title":"Mortality, Length of Stay, and Healthcare Costs Associated with Multidrug-Resistant Bacterial Infections Among Elderly Hospitalized Patients in the United States","volume":"74","author":"Nelson","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Dijkmans, A.C., Zacar\u00edas, N.V.O., Burggraaf, J., Mouton, J.W., Wilms, E.B., Van Nieuwkoop, C., Touw, D.J., Stevens, J., and Kamerling, I.M.C. (2017). Fosfomycin: Pharmacological, Clinical and Future Perspectives. Antibiotics, 6.","DOI":"10.3390\/antibiotics6040024"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.cmi.2016.12.005","article-title":"Intravenous Fosfomycin: Back to the future. Systematic review and meta-analysis of the clinical literature","volume":"23","author":"Grabein","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.ijantimicag.2013.09.010","article-title":"Outcomes of critically ill intensive care unit patients treated with Fosfomycin for infections due to pandrug-resistant and extensively drug-resistant carbapenemase-producing Gram-negative bacteria","volume":"43","author":"Pontikis","year":"2014","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kollef, M.H., Shorr, A.F., Bassetti, M., Timsit, J.-F., Micek, S.T., Michelson, A.P., and Garnacho-Montero, J. (2021). Timing of antibiotic therapy in the ICU. Crit. Care, 25.","DOI":"10.1186\/s13054-021-03787-z"},{"key":"ref_8","unstructured":"(2025, June 16). Fosfomycin SmPC, EMA, 2017 April 6. Available online: https:\/\/www.ema.europa.eu\/en\/documents\/psusa\/fosfomycin-iv-formulation-list-nationally-authorised-medicinal-products-psusa00010336201607_en.pdf."},{"key":"ref_9","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_10","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1179\/joc.2005.17.5.527","article-title":"Second-line Treatment of Limb-Threatening Diabetic Foot Infections with Intravenous Fosfomycin","volume":"17","author":"Stengel","year":"2005","journal-title":"J. Chemother."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Biscarini, S., Mangioni, D., Bobbio, C., Mela, L., Alagna, L., Baldelli, S., Blasi, F., Canetta, C., Ceriotti, F., and Gori, A. (2024). Adverse events during intravenous fosfomycin therapy in a real-life scenario. Risk factors and the potential role of therapeutic drug monitoring. BMC Infect. Dis., 24.","DOI":"10.1186\/s12879-024-09541-4"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.ijantimicag.2010.09.002","article-title":"Adverse events associated with intravenous Fosfomycin","volume":"37","author":"Florent","year":"2011","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2045","DOI":"10.1093\/cid\/ciz181","article-title":"Fosfomycin for Injection (ZTI-01) Versus Piperacillin-tazobactam for the Treatment of Complicated Urinary Tract Infection Including Acute Pyelonephritis: ZEUS, A Phase 2\/3 Randomized Trial","volume":"69","author":"Kaye","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Savaj, P., Davda, K., Sunavala, A., and Soman, R. (2018). Our Experience with IV Fosfomycin. Open Forum Infect. Dis., 5.","DOI":"10.1093\/ofid\/ofy210.2065"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1128\/CMR.00068-15","article-title":"Fosfomycin","volume":"29","author":"Falagas","year":"2016","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_17","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."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1007\/s15010-019-01323-4","article-title":"Current clinical use of intravenous Fosfomycin in ICU patients in two European countries","volume":"47","author":"Putensen","year":"2019","journal-title":"Infection"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Malnic, G., Muto, S., and Giebisch, G. (2008). Regulation of Potassium Excretion. Seldin and Giebisch\u2019s The Kidney, Academic Press.","DOI":"10.1016\/B978-012088488-9.50050-4"},{"key":"ref_20","first-page":"47","article-title":"Magnesium Metabolism and its Disorders","volume":"24","author":"Swaminathan","year":"2003","journal-title":"Clin. Biochem. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2107","DOI":"10.1093\/jn\/126.9.2107","article-title":"Sodium Excretion Influences Calcium Homeostasis in Elderly Men and Women","volume":"126","author":"Fowler","year":"1996","journal-title":"J. Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Canamares-Orbis, I., Silva, J.T., L\u00f3pez-Medrano, F., and Aguado, J.M. (2015). Is high-dose intravenous Fosfomycin safe for the treatment of patients prone to heart failure?. Enfermedades Infecc. Microbiol. Cl\u00ednica, 33.","DOI":"10.1016\/j.eimc.2014.07.005"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.ijcard.2016.02.037","article-title":"Monitoring of high-dose Fosfomycin guided by NT-proBNP","volume":"209","author":"Candel","year":"2016","journal-title":"Int. J. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4386\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:55:20Z","timestamp":1760032520000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/12\/4386"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":23,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["jcm14124386"],"URL":"https:\/\/doi.org\/10.3390\/jcm14124386","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,19]]}}}