Trial data support oral transition therapy in patients with complicated UTIs

News brief

multicolored pills and syringe on top of paper with urinary tract infection definition — arun011 / iStock

The results of a randomized clinical trial conducted in South Korea suggest oral fosfomycin is noninferior to intravenous (IV) carbapenem antibiotics when used as a transition therapy for patients with complicated urinary tract infections (cUTIs) caused by multidrug-resistant bacteria, researchers reported last week in Clinical Infectious Diseases.

The trial, conducted at four tertiary hospitals in South Korea from November 2022 to June 2025, randomized patients with cUTIs caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales who had improved after three to seven days of IV carbapenems to switch to oral fosfomycin, or continue IV therapy. The primacy outcome was clinical cure. The noninferiority margin was 15%.

While IV carbapenems are the primary antibiotic treatment for cUTIs caused by ESBL-producing Enterobacterales, there is concern that reliance on carbapenems is driving the emergence of carbapenem-resistant Enterobacterales, which have even fewer treatment options. Oral fosfomycin, used in patients with uncomplicated UTIs, is viewed as a potential carbapenem-sparing option, but data on its effectiveness in treating cUTIs are limited.

“Fosfomycin has favorable oral bioavailability and maintains activity against ESBL-producing Enterobacterales,” researchers from Chosun University and the National Institute of Infectious Diseases wrote. “Although approved only for acute uncomplicated cystitis, it is increasingly used off-label in clinical practice for complicated UTIs because of its preserved susceptibility profile.”

Clinical cure rates are similar

Of the 299 patients included in the trial, 152 received oral fosfomycin and 147 received continued IV carbapenems. Clinical cure was achieved in 92.8% of the oral fosfomycin patients and 95.2% of the IV therapy group. The risk difference of –2.47 percentage points confirmed the noninferiority margin.

A secondary outcome, microbiologic cure, was high in both groups, and the safety profile and 30-day outcomes were comparable.

“This randomized trial shows that patients with complicated UTIs caused by ESBL-producing Enterobacterales who transitioned to oral fosfomycin did just as well as those receiving continued intravenous therapy, supporting the strategy as a way to facilitate oral transition and hospital discharge,” the authors concluded.

US tops 2,100 measles cases so far this year, putting it on track to surpass 2025 total

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Chris Dall, MA

Boys arm with measles rash — Natalya Maisheva / iStock

The United States added 31 newly confirmed measles infections last week, bringing its total for the year to 2,104, according to the latest update from the Centers for Disease Control and Prevention (CDC).

The new cases bring the country closer to the 2,288 confirmed measles case reported for all of 2025. All but 11 of this year’s cases were locally acquired, with the rest related to travel outside the country. A total of 30 outbreaks have been reported, with no new outbreaks since the previous CDC update. There were 48 outbreaks reported in 2025.

Of this year’s measles cases, 21% are in children age 5 and under, and 51% involve kids aged 5 to 19. Six percent of patients have been hospitalized, compared with 11% in 2025. Among all measles patients, 93% are unvaccinated or have unknown vaccine status.

Virginia adds 19 new cases

Among the current hot spots is Virginia, which now has 129 reported measles cases, up 19 from the previous week, according to the Virginia Department of Health. Most of the case are tied to an ongoing outbreak in Buckingham County that began in May. Virginia reported only five measles cases in 2025.

South Carolina continues to have the most cases this year, with 670, but the large outbreak in the Upstate region is now over. Utah is next, with 498 cases, up eight from the previous week, according to the CDC measles map (though the Utah health department lists 490 cases).

Since June 20 of last year, when an outbreak began in under-vaccinated communities on the Utah-Arizona border, Utah has reported 680 measles cases across 22 of 29 counties. Although cases are slowing in the state, state epidemiologist Leisha Nolen, MD, PhD, told the Associated Press that she’s worried they could easily pick up again.

“We just need those few cases to hit the wrong community and it could flare up really big again,” she said.

Texas has reported the third most cases for 2026, with 182. Florida is next, with 141 cases.

Quick takes: Flu sickens US troops, Texas reports 3 more NWS cases, eligibility expands for pneumococcal vaccine

News brief

Mary Van Beusekom, MS

Two months after Defense Secretary Pete Hegseth lifted the requirement for US troops to be vaccinated against influenza, the virus has infected nearly 160 people undergoing basic military training at Lackland Air Force Base in San Antonio, Texas, The Hill reports. The 37th Training Wing is isolating and treating the sick trainees and monitoring close contacts, the news outlet said. Last week, the 37th Training Wing announced that a trainee from the 737th Training Support Squadron died at the base after experiencing a medical emergency, which is under investigation. In April, Hegseth said ending the flu vaccine mandate would give troops “freedom to express their religious convictions.”
Cases of New World screwworm (NWS) in US livestock are now at 15 with the addition of three new infections in Texas, the US Department of Agriculture’s Animal and Plant Health Inspection Service reported over the weekend. All but one of the 15 cases has been identified in Texas, where the first infection was diagnosed in a calf in early June; the other infection was reported in New Mexico. Earlier this month, the Centers for Disease Control and Prevention said it had officially activated a Level 3 (lowest-level) emergency response to NWS. The infection is caused by parasitic fly larvae that feed on the tissue of living animals.
The US Food and Drug Administration has expanded eligibility for Merck’s Capvaxive pneumococcal vaccine, the company said in a news release. In addition to adults, children and adolescents aged 2 through 17 years are now eligible if they completed a primary pediatric pneumococcal vaccination series and have at least one chronic medical condition that puts them at higher risk for pneumococcal illness. A 21-strain conjugate vaccine, Capvaxive is the only such vaccine indicated for this population in the United States. It contains serotypes not included in the primary pediatric vaccine series for added protection, Merck said.