Öz
Amaç
İntravenöz (IV) fosfomisin, dirençli patojenler için kombinasyon tedavilerinde yaygın olarak kullanılmaktadır. Bu çalışma, hastaneye yatırılmış hastalarda IV fosfomisin’in neden olduğu elektrolit bozuklukları (EB) sıklığını ve risk faktörlerini araştırmayı amaçlamaktadır.
Yöntemler
Bu çalışma, 2023 Şubat ile 2024 Şubat tarihleri arasında altı farklı merkezde gerçekleştirilen prospektif, çok merkezli, gözlemsel bir kohort çalışmasıdır. Naranjo advers ilaç reaksiyonu olasılık ölçeği (NADRPS), EB ile IV fosfomisin kullanımı arasındaki ilişkiyi değerlendirmiştir.
Bulgular
Çalışmaya toplamda yaş ortalaması [çeyrekler arası aralık (ÇAA)] 60 (35-73) yıl olan 54 hasta dahil edilmiştir. Hastaların çoğu (%38,8) yoğun bakım ünitesinde (YBÜ) yatırılmıştır. IV fosfomisin medyan (ÇAA) dozu 12 g (ÇAA: 12-18) olup tedavi süresi ortalama 13,2±7,2 gündür. Hipokalemi 28 hastada (%51,8) ve hipernatremi 10 hastada (%18,5) görülmüştür. NADRPS skorları, hastaların EB’leri ile uyumlu bulunmuştur. ESBL pozitif hastalarda hipokalemi insidansı daha yüksekti (%63,4 vs. %30,7, p=0,04). Hipokalemik hastalarda hipernatremi insidansı, hipokalemisi olmayanlardan anlamlı derecede yüksekti (%90 vs. %46,1, p=0,013). EB’li hastalarda mortalite oranı, EB’siz hastalara göre anlamlı derecede yüksekti ve odds oranı (OR) 6,25 [%95 güven aralığı (GA): 1,82-20, p=0,002] olarak bulunmuştur. Ayrıca, ESBL (+) varlığı ve pozitif sıvı dengesi, sırasıyla OR’leri 3,77 (%95 GA: 1,09-13,10, p=0,032) ve 5,40 (%95 GA: 1,12-26,04, p=0,03) ile artmış EB riski ile ilişkilendirilmiştir.
Sonuç
IV fosfomisin ile elektrolit anormallikleri arasındaki ilişki, özellikle YBÜ hastalarında dikkatle değerlendirilmelidir. Klinik uzmanlar, IV fosfomisin tedavisi sırasında elektrolit düzeylerini düzenli olarak izlemeli, potansiyel riskleri en aza indirirken hasta güvenliğini sağlamalıdır.
Anahtar Kelimeler: Fosfomisin, elektrolit bozukluğu, hipernatremi, hipokalemi, yoğun bakım ünitesi
Kaynakça
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