LAUSR

Abstract Background Oral fosfomycin is a treatment option for urinary tract infections (UTI) caused by multi-drug-resistant organisms (MDRO). The objective of the study was to describe the prescribing pattern of fosfomycin and determine its role in (1) preventing hospital admissions for patients seen in the emergency department or (2) promoting earlier discharges for admitted patients. Methods This retrospective chart review evaluated adults that received at least one dose of fosfomycin during the period 2014–2017. Information was collected using electronic medical records (e.g., demographics, symptoms, dose/duration of fosfomycin, urine culture results, length of stay, and hospital readmission). Statistical analysis was performed using descriptive statistics. Results Forty-three patients were included (60.5% females). Nearly half of the population (48.8%) had a history of recurrent UTIs. Patients received fosfomycin for cystitis (58.1%), pyelonephritis (34.9%), and asymptomatic bacteriuria (7%). Only two patients received >1 dose. Empiric use of fosfomycin was seen in only 9.3%. Of those treated based on culture results, 84.6% of patients had MRDOs (29 ESBL, 2 VRE, 1 KPC, 1 resistant-Pseudomonas). No isolates had fosfomycin susceptibilities performed. In 72% of the time, patients had no other oral options. In 74.3% of the time, fosfomycin was used as step-down therapy from intravenous (IV) antibiotics (e.g., carbapenems 69%, ceftriaxone 13.8%). Infectious Diseases was consulted on 81.4% of cases. Seven percent of patients had documented allergies to the preferred agent. Treatment success was seen in 93% of patients, while three patients failed treatment requiring readmission for IV therapy. Fosfomycin use resulted in earlier discharge in 75.8% of cases (range of 1–6 days, mean 2.92 hospital days avoided per patient). For those who received fosfomycin as part of their emergency visit, 90% (9 of 10) were able to avoid hospitalization. Conclusion In our study, fosfomycin was used in UTI caused by MRDOs, with treatment successfully demonstrated in a majority of patients. Fosfomycin allowed for patients to avoid hospitalization or promoted earlier discharge, on average 3 days sooner than anticipated. Use of fosfomycin should be considered in appropriate patients in an effort to decrease length-of-stay or altogether avoid hospitalization. Disclosures All authors: No reported disclosures.