Fosfomycin monotherapy for the treatment of a complicated prostatic abscess caused by KPC-producing carbapenem-resistant Escherichia coli
- 1Vietnamese-German Center for Medical Research (VG-CARE), 108 Military Central Hospital, Hanoi, Vietnam
- 2Institute of Clinical Infectious Diseases, 108 Military Central Hospital, Hanoi, Vietnam
- 3Department of Functional Exploration, 108 Military Central Hospital, Hanoi, Vietnam
Abstract
Background: Prostatic abscess caused by carbapenem-resistant Escherichia coli (CREC) is an uncommon but serious infection with limited therapeutic options, particularly when prolonged antimicrobial therapy and oral step-down treatment are required. Evidence supporting fosfomycin monotherapy for prostatic abscess caused by CREC remains scarce.
Case Summary: A 67-year-old man with diabetes mellitus and prolonged corticosteroid exposure presented with severe sepsis secondary to a multiloculated prostatic abscess measuring 57.2 × 38.7 × 49.4 mm. Urine and abscess cultures yielded KPC-producing CREC susceptible to fosfomycin (MIC = 0.25 μg/mL) and amikacin. Because access to newer β-lactam/β-lactamase inhibitor agents was limited, treatment was initiated with intravenous fosfomycin plus amikacin. Amikacin was discontinued after 2 days because of nephrotoxicity, and therapy was successfully continued with intravenous fosfomycin monotherapy following transperineal ultrasound-guided abscess drainage. The patient received intravenous fosfomycin 6 g every 8 h for 21 days, followed by oral fosfomycin calcium 3 g every 24 h for 30 days, with complete clinical and radiological resolution, and no relapse during 6 months of follow-up.
Conclusion: Although the initial brief course of amikacin may have contributed to early bacterial clearance, the majority of treatment was administered as fosfomycin monotherapy after adequate source control. This case suggests that antibiotic susceptibility test-guided fosfomycin monotherapy, combined with adequate drainage, is a feasible treatment for prostatic abscesses caused by CREC, particularly in resource-limited settings.
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BibTeX
@article{tuyen2026fosfomycin,
title = {{Fosfomycin monotherapy for the treatment of a complicated prostatic abscess caused by KPC-producing carbapenem-resistant Escherichia coli}},
author = {Nguyen Thi Tuyen and Nguyen Sy Thau and Pham Thi Thanh Nhan and Nguyen Van Tuan and Nguyen Trong The},
journal = {ASM case reports},
year = {2026},
month = sep,
doi = {10.1128/asmcr.00112-26},
url = {https://europepmc.org/article/PMC/PMC13729746},
note = {CC BY},
}
RIS
TY - JOUR
TI - Fosfomycin monotherapy for the treatment of a complicated prostatic abscess caused by KPC-producing carbapenem-resistant Escherichia coli
AU - Nguyen Thi Tuyen
AU - Nguyen Sy Thau
AU - Pham Thi Thanh Nhan
AU - Nguyen Van Tuan
AU - Nguyen Trong The
PY - 2026
DA - 2026/09/15
JO - ASM case reports
DO - 10.1128/asmcr.00112-26
UR - https://europepmc.org/article/PMC/PMC13729746
AB - Background: Prostatic abscess caused by carbapenem-resistant Escherichia coli (CREC) is an uncommon but serious infection with limited therapeutic options, particularly when prolonged antimicrobial therapy and oral step-down treatment are required. Evidence supporting fosfomycin monotherapy for prostatic abscess caused by CREC remains scarce. Case Summary: A 67-year-old man with diabetes mellitus and prolonged corticosteroid exposure presented with severe sepsis secondary to a multiloculated prostatic abscess measuring 57.2 × 38.7 × 49.4 mm. Urine and abscess cultures yielded KPC-producing CREC susceptible to fosfomycin (MIC = 0.25 μg/mL) and amikacin. Because access to newer β-lactam/β-lactamase inhibitor agents was limited, treatment was initiated with intravenous fosfomycin plus amikacin. Amikacin was discontinued after 2 days because of nephrotoxicity, and therapy was successfully continued with intravenous fosfomycin monotherapy following transperineal ultrasound-guided abscess drainage. The patient received intravenous fosfomycin 6 g every 8 h for 21 days, followed by oral fosfomycin calcium 3 g every 24 h for 30 days, with complete clinical and radiological resolution, and no relapse during 6 months of follow-up. Conclusion: Although the initial brief course of amikacin may have contributed to early bacterial clearance, the majority of treatment was administered as fosfomycin monotherapy after adequate source control. This case suggests that antibiotic susceptibility test-guided fosfomycin monotherapy, combined with adequate drainage, is a feasible treatment for prostatic abscesses caused by CREC, particularly in resource-limited settings.
SN - 2996-2684
ER -