We are grateful for the correspondence and are of course happy to address controversial or unclear issues.
We are likewise convinced that intravenous fosfomycin is an important antibiotic against 3/4 MRGN pathogens, and we use it regularly. For this reason, we listed it several times in Table 1, Table 2, in the article text, and in the Key Messages. Table 2—as stated in the N.B.—is to be considered as a series of therapy proposals (1). It makes sense to decide which antibiotic scheme should be used based on interdisciplinary discussions about patient- and pathogen-specifics for individual cases.
Therapy recommendations initially refer to carbapenem-resistant pathogens without a description of the severity of infection. From these options (and possibly others, based on specific considerations of the patient with reference especially to the infection focus and relevant contraindications), a therapy concept can be selected individually, whereby a patient with sepsis should generally receive intravenous treatment.
In Table 1, we explicitly referred to uncomplicated lower urinary tract infections for oral fosfomycin. We have authorized a correction of the article to clarify that oral fosfomycin is generally only approved for uncomplicated lower urinary tract infections. Whether or not oral fosfomycin is an option in complicated urinary tract infections should be tested in RCTs. However, if it is the only antibiotic with susceptibility, we certainly see it as an option to be discussed—provided that no better alternatives are available.
We agree that electrolyte control normally works in ICU patients, and heart failure is a rare adverse reaction, with a probability of 0.07% (2). Nevertheless, we would like to draw attention to electrolyte imbalance as an important adverse reaction, so that it is not overlooked.
On behalf of the authors
Prof. Dr. rer. nat. Trinad Chakraborty
Zentrum für medizinische Mikrobiologie
Koordinator DZIF Gießen-Marburg-Langen, Germany
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Fritzenwanker M, Imirzalioglu C, Herold S, Wagenlehner FM, Zimmer KP, ChakrabortyT: Treatment options for carbapenem-resistant gram-negative infections. Dtsch Arztebl Int 2018; 115: 345–52 VOLLTEXT|