The Effect of Administration of Fosfomycin in the Treatment of Ventilator Associated Pneumonia in Respiratory Intensive Care Unit and Poison Control Centre in Ain Shams University Hospitals

Abstract

Ventilator associated pneumonia (VAP) is pneumonia developing in a mechanically ventilated patient more than 48 hours after tracheal intubation. The mortality associated with VAP is high. VAP increases the cost of care and utilization of the resources. Over the past several decades our understanding of VAP has grown significantly regarding pathogenesis, risk factors, diagnostic testing, therapies, and prevention by modifying risk factors. The incidence of infections caused by multidrug-resistant (MDR) Gram-negative bacteria has increased worldwide during the last decade. In the face of both increasing antimicrobial resistance and a dearth of novel antibiotics, it has become clear that we need new strategies. One of these must be to revisit old, still active antibiotics and explore their potential for synergistic activity when used in combination (e.g. polymyxins, fosfomycin, tetracyclines, etc.) in the treatment of MDR Gram-negative bacterial infections. To date, only a few studies have investigated the use fosfomycin in the treatment of VAP. In view of the above, the present study was undertaken to assess the effect of oral administration of Fosfomycin in the treatment of ventilator associated pneumonia. The study included 25 males & 15 females ranging in age from 18 to 81 years with a mean age of 51.85 ± 17.07 years who were diagnosed with VAP. They were classified into two groups where oral fosfomycin was used as adjunctive treatment in comparison to empirical antibiotics alone. The results obtained were collected, tabulated and submitted for statistical analysis. The following results were obtained: 1. Among the studied patients; VAP was more prevalent in males (25 were males & 15 females). 2. Early onset VAP was more common than late onset VAP. 3. The overall Mortality rate was 42.5% of the study population. 4. Generally, Gram negative bacteria was the most commonly observed pathogen. 5. klebsiella pneumonie was the most common pathogen found in early onset VAP endotracheal tube aspirate cultures followed by acintobacter MDR followed by, streptococcus pneumonie. 6. In late onset VAP, acintobacter MDR was the most common pathogen found followed by klebsilla pneumonie. 7. There is No significant difference between the two groups regarding improvement and mortality.