Ispitivanje učinkovitosti različitih shema doziranja fosfomicina u liječenju infekcija urinarnog trakta uzrokovanih sojevima E. coli i K. pneumoniae koje proizvode beta laktamaze proširenoga spektra

doctoral thesis

• Title (english): Prospective controlled clinical trial of different fosfomycin dose regiments in the treatment of urinary tract infections caused by extended spectrum beta lactamase producing strains of E. coli and K. pneumoniae
• Author: Luka Bielen
• Mentor: Robert Likić (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2015-01-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

U eri porasta rezistencije na antibiotike, ESBL bakterijski sojevi predstavljaju značajan terapijski problem. Zbog toga posljednjih godina raste interes za istraživanjem starijih antibiotika poput fosfomicina, posebno zbog njegove oralne primjene i niske cijene. Temeljna hipoteza ove dizertacije, u skladu s dosadašnjim istraživanjima bila je da doziranje fosfomicina po shemi 3 g svaki drugi dan kroz 5 dana u značajno većem postotku slučajeva dovodi do izlječenja kompliciranih infekcija urinarnog trakta, u odnosu na jednokratnu primjenu fosfomicina, gledajući stope mikrobiološkog i kliničkog izlječenja. Također je bilo pretpostavljeno da je fosfomicin klinički učinkovita terapija u liječenju ovih infekcija. Obje su hipoteze potvrđene rezultatima ovog prospektivnog kliničkog ispitivanja. Konačno, utvrđena je pretpostavljena izrazito visoka in vitro osjetljivost ESBL sojeva E. coli na fosfomicin, što omogućava empirijsku primjenu, dok je stopa osjetljivosti ESBL sojeva K. pneumoniae bila značajno niža. Buduća klinička istraživanja u ovom području vjerojatno bi trebala biti usmjerena na ispitivanje još dužih terapijskih shema doziranja fosfomicina ili upotrebu kombinacija antibiotika s različitim mehanizmom djelovanja, poput fosfomicina i nitrofurantoina.

Abstract (english)

In the era of rising antibiotic resistance rates, bacterial ESBL producing strains represent a major therapeutic problem. Hence, during the last years there is a growing interess in the investigation of older antibiotics like fosfomycin, especially due to its' oral route of administration and low cost. The main hypothesis of this doctoral thesis, in concordance with previous research, was that fosfomycin dose regimen in three divided doses during five days compared to a single dose, leads to better tretment outcomes of complicated urinary tract infections, in terms of both microbiological and clinical cure rates. It has also been assumed that fosfomycin is an effective treatment option for these infections. Both hypotheses have been confirmed by the results of this prospective clinical trial. Lastly, assumed extremly high in vitro susceptibility to fosfomycin of ESBL E. coli strains has been demonstrated, which enables empirical fosfomycin use, whereas in vitro sensitivity of ESBL K. pneumoniae strains was much lower. Future clinical research in this field should probably be directed to even more prolonged clinical courses of fosfomycin or the use of antibiotic combinations with different mechanisms of action, such as fosfomycin and nitrofurantoin.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:776225
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 86 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 07:28:10