Fuentes de estrés en el entorno laboral universitario como factores de riesgo del Síndrome de Burnout: un estudio mixto

Introducción: El síndrome del profesional quemado o síndrome de burnout surge como una respuesta al estrés laboral crónico, presente sobre todo en aquellos trabajadores de servicios con fuertes demandas sociales y contacto directo con los usuarios del servicio. Maslach y Jackson presentaron una definición operativa del burnout [1], el ‘Maslach Burnout Inventory’, que llegaría a ser considerada gold estándar del síndrome durante mucho tiempo. Esta definición puso en el punto de mira las respuestas emocionales de los trabajadores afectados, destacando la presencia de síntomas de cansancio emocional, despersonalización y falta de realización personal. El cansancio emocional se refiere a una pérdida progresiva de la capacidad de entrega en el trabajo y representa una dimensión individual del burnout. La despersonalización lleva consigo cierto distanciamiento emocional hacia los destinatarios del servicio, mediante la adopción de conductas impersonales, insensibles o endurecidas y hace referencia al contexto interpersonal del trabajador. La falta de realización personal estaría presente en trabajadores profesionalmente descontentos, desmotivados e insatisfechos, como resultado de una auto-evaluación negativa de sus propios logros o satisfacciones en lo relativo a la esfera laboral. Planteada originalmente para dar cobertura a profesiones de tipo asistencial o de servicios, esta definición ha sido reconceptualizada para mejorar su validez factorial y también para conseguir su aplicabilidad en todo tipo de ocupaciones, así pasa a definirse el síndrome de burnout como "una respuesta prolongada a estresores crónicos a nivel personal y relacional en el trabajo, determinado a partir de las dimensiones conocidas como agotamiento, cinismo e ineficacia profesional [2], que constituyen el ‘Maslach Burnout Inventory General Survey’. El agotamiento sería la sensación de no poder dar más de sí a nivel emocional, como consecuencia de una exposición prolongada a las exigencias laborales. El cinismo se refiere a la falta de interés y a la pérdida de significado, así como a la indiferencia y al distanciamiento hacia el trabajo. La ineficacia sería la percepción de no hacer adecuadamente las tareas y la sensación de ser incompetente en el puesto asignado. El síndrome de burnout se presenta a través de tres distintos perfiles de burnout, los subtipos: ‘frenético’, ‘sin desafíos’ y ‘desgastado’, cada uno de los cuales presentaría un modo singular de afrontar el malestar laboral [3,4]. El subtipo frenético, vendría a ser una categoría de sujetos que trabajan cada vez más duro hasta el agotamiento, buscando éxitos a la altura de la tensión ocasionada por sus esfuerzos. El subtipo sin-desafíos, lo conformarían trabajadores insuficientemente retados, que han de afrontar condiciones laborales poco estimulantes, que no proporcionan la satisfacción necesaria. El subtipo de burnout desgastado, estaría formado por personas que enseguida se rinden frente al estrés o la ausencia de gratificaciones. Objetivos: Identificar las fuentes de estrés laboral que afectan a los empleados de un entorno universitario y averiguar su capacidad predictiva respecto al Síndrome del profesional quemado o Síndrome de Burnout. Método: Se utilizará una metodología de análisis cuali-cuantitativo (QQA), mediante un diseño transversal con una encuesta auto-administrada online, sobre una muestra multiocupacional de trabajadores de la universidad, seleccionados aleatoriamente (n=429), utilizando como universo poblacional de referencia la totalidad de los trabajadores de la Universidad de Zaragoza, empleados en enero de 2008 (N=5,493). Serán seleccionados por ser una población con alto riesgo de desarrollo del burnout, puesto que está formada por profesionales que trabajan “cara a cara” con otras personas [5]. Para alcanzar un entendimiento amplio de todos los participantes y de la complejidad de su entorno, por las múltiples y diferentes situaciones individuales posibles, se utilizará una metodología de análisis mixto o cuali-cuantitativo (QQA) que ofrece una aproximación de investigación que combina las técnicas cualitativas y las cuantitativas, superando las limitaciones de ambas tradiciones, y abriendo las puertas a un modelo holístico capaz de afrontar contextos complejos [6]. Medidas: Fuentes de estrés laboral. Para descubrir las fuentes de estrés que están afectando a los participantes en su contexto de trabajo, se planteará la siguiente pregunta abierta: “Describa brevemente una situación que le haya producido estrés en los últimos seis meses”. Los participantes podrán contestar libremente a dicha pregunta, escribiendo en sus propios términos, en un hueco asignado para ello sin límite de palabras ni de tiempo. Características sociodemográficas y ocupacionales. A partir de una serie de preguntas específicamente preparadas, se interrogará sobre las características sociodemográficas y ocupacionales como son la edad, sexo, relaciones estables (‘si’ vs. ‘no’), nivel de educación (‘secundaria o inferior’, ‘universitario’, ‘doctorado’), ocupación (‘PDI’, ‘PAS’, ‘BEC’), años de servicios (‘16 años’), baja laboral en el año previo (‘si’ vs. ‘no’), y tipo de contrato (‘tiempo completo’ vs. ‘tiempo parcial’). Síndrome de Burnout Para valorar el Síndrome de Burnout se empleará el " Inventario General de Burnout de Maslach" (MBI-GS), en su versión validada en español. Esta adaptación se compone de 15 ítems agrupados en tres dimensiones: agotamiento (por ejemplo, "Me siento emocionalmente agotado por mi trabajo"), el cinismo (por ejemplo, "Me he vuelto más insensible hacia la gente desde que empecé este trabajo") y eficacia (por ejemplo, "me siento muy eficaz resolviendo los problemas de mi trabajo"). Las respuestas se organizan en una escala tipo Likert con 7 opciones de respuesta, desde 0 ("nunca") a 6 ("siempre"). Los resultados se presentan en puntuaciones escalares. Todas las dimensiones del cuestionario presentan una consistencia interna de α ≥ 0.7816 [7]. Subtipos de burnout: Para valorar los subtipos de burnout, se administrará el “Cuestionario de Subtipos Clínicos de Burnout” (BCSQ-36) [8]. Este cuestionario está formado por 36 ítems, distribuidos en 3 escalas y 9 sub-escalas (con 4 ítems cada una). La escala del subtipo frenético contempla la implicación (por ejemplo, “Reacciono a las dificultados de mi trabajo con mayor participación”), ambición (por ejemplo, “Tengo una gran necesidad de logros importantes en mi trabajo”) y sobrecarga (por ejemplo, “Paso por alto mis propias necesidades por cumplir con las exigencias del trabajo”); la del subtipo sin-desafíos está formada por la indiferencia (por ejemplo, “Me siento indiferente con mi trabajo y tengo pocos deseos de triunfar”), falta de desarrollo (por ejemplo, “Mi trabajo no me ofrece oportunidades de desarrollar mis habilidades”) y aburrimiento (por ejemplo, “Me aburro en el trabajo”); la del subtipo desgastado comprende el abandono (por ejemplo,. “Cuando las cosas no salen como deberían en el trabajo, dejo de intentarlas”), falta de reconocimiento (por ejemplo, “Creo que no se reconoce mi dedicación al trabajo”) y falta de control (por ejemplo, “Siento que los resultados de mi trabajo están fuera de mi control”). Los sujetos han de indicar su grado de acuerdo respecto a las frases presentadas, mediante una escala tipo Likert con 7 opciones de respuesta, puntuadas desde 1 (“totalmente en desacuerdo”) a 7 (“totalmente de acuerdo”). El BCSQ-36 presenta una definición del burnout con una estructura factorial, validez convergente y consistencia interna adecuadas, con valores α≥0.80 para cada una de las dimensiones [8,9]. Las respuestas serán analizadas mediante análisis de contenido temático, y serán categorizadas por tres jueces independientes. La presencia del síndrome de burnout se evaluará mediante el “Maslach Burnout Inventory-General Survey” (MBI-GS) y los subtipos se evaluarán mediante el “Burnout Clinical Subtype Questionnaire” (BCSQ-36). El grado de asociación entre los motivos de queja y la presencia de burnout y los perfiles de burnout se valorará utilizando odds ratio (OR) ajustadas, a partir de modelos de regresión logística multivariante. Se realizará un análisis descriptivo de las características sociodemográficas y ocupacionales, utilizando medias, desviaciones estándar y porcentajes, según la naturaleza de las variables, así como un análisis de contenido temático y un análisis de regresión logística

Resiliencia: impacto positivo en la salud física y mental

Resilience is characterized by effective coping with stressful events and depends on the specific characteristics of stressful situations and individuals, as well as the interaction of the person and their human environment. Resilience in health has been conceptualized as the ability to maintain good health in the midst of great adversity, a capacity that can emerge in relational development, acquiring in the environment. Research on established relationships between resilience and physical health is scarce; however, research on resilience and mental health is extensive, focusing mainly on psychological variables and pathologies such as stress, anxiety and depression. This paper reviews the positive impact on the physical and mental health of resilience from current knowledge.La resiliencia se caracteriza por un afrontamiento efectivo de los eventos estresantes y depende de las características específicas de las situaciones estresantes y de los individuos, así como de la interacción de la persona y su entorno humano. La resiliencia en salud se ha conceptualizado como la capacidad de mantener una buena salud en medio de una gran adversidad, capacidad que puede emerger en el desarrollo relacional, adquiriéndose en el ambiente. Es escasa la investigación llevada a cabo sobre relaciones establecidas entre la resiliencia y la salud física; sin embargo, es amplia la investigación en resiliencia y salud mental, centrada principalmente en variables psicológicas y patologías como el estrés, la ansiedad y la depresión. Este trabajo realiza una revisión, desde los conocimientos actuales, del impacto positivo para la salud física y mental de la resiliencia

Protocolo para el diseño de una escala específica de auto-eficacia en la adherencia a una dieta sin gluten: Escala de celiaquía y auto-eficacia

Background: Celiac disease is a chronic autoimmune disorder consisting of a permanent intolerance for gluten, with a prevalence of 1%, for which the only treatment to date is to follow a strict gluten free diet for life. Lack of adherence to this treatment is related to severe health problems while compliance leads to normalization. Recently, self-efficacy has been associated with self-management behaviors in chronic disease and health status in many fields.Aims: To construct and validate a self-administered scale to measure self-efficacy in adherence to gluten free diet in the different areas a patient with celiac disease must face everyday.Material and Methods: For the validation phase, the research team aims to recruit 500 celiac individuals over 12 years of age from primary care services and patient associations. The scale will be designed to explore specific self efficacy to adhere to a gluten free diet in the following areas: purchases, eating out, eating at home with others, travelling and at work or school. An expert panel will be conducted to assure quality of the items and utility of the scale. The preliminary form will be tested in as many pilot studies as necessary. An exploratory factor analysis will be applied to study construct validity while concurrent validity will be measured with the correlation coefficient between the new instrument and the Baessler and Schwarzer General Self Efficacy Scale. The reliability of the instrument as well as that of each of the factors extracted from the prior analysis will be analyzed using Cronbach’s alpha internal consistency coefficient. Two weeks later, the scale will be administered to, at least, one third of the sample as a retest in the validation process and to allow for confirmatory factor analysis.Results: This research will design, develop and validate a questionnaire for two types of measures: A score for Self-Efficacy for the management of celiac disease, and a score of self-efficacy for each of the identified key areas. This research will result in the first scale to assess specific self efficacy while following a strict gluten free diet and will allow further research in the role that this expectation may play in patient´s adherence to the unique treatment developed to date and it may be useful in both clinical and research settings. The new scale will be easy to apply and it is expected to have a higher predictive value than instruments assessing general self-efficacy.Conclusions: This questionnaire will be the first of its kind to determine levels of self-efficacy for adherence to gluten free diet and will help to the design of self-management interventions for celiac patients.Antecedentes: La enfermedad celíaca es un trastorno autoinmune crónico, caracterizado por una intolerancia permanente al gluten, con una prevalencia del 1%, y para la que el único tratamiento hasta la fecha consiste en seguir una dieta estricta libre de gluten de por vida. La falta de adherencia a este tratamiento está relacionada con problemas de salud graves, mientras que el cumplimiento conduce a la normalización. Recientemente, la auto-eficacia se ha asociado con comportamientos de autogestión de las enfermedades crónicas y el estado de salud en muchos campos.Objetivos: Diseñar y validar una escala para medir la auto-eficacia en la adherencia a una dieta libre de gluten en los diferentes ámbitos a los que se enfrentan todos los días los pacientes con enfermedad celíaca.Material y Métodos: Para el proceso de validación, el equipo de investigación reclutará a 500 personas diagnosticadas de enfermedad celíaca, de más de 12 años de edad, a partir de los servicios de atención primaria y las asociaciones de pacientes. Se diseñará una escala para explorar la autoeficacia específica en la adherencia a una dieta sin gluten en las siguientes áreas: compras, comer fuera de casa, comer en casa con otros, viajar y comer en el trabajo o en el colegio. Se llevará a acabo un panel de expertos para asegurar la calidad de los ítems y la utilidad de la escala. Se realizarán los estudios piloto que sean necesarios para su mejora y se analizará su validez de constructo mediante un análisis factorial exploratorio mientras que la validez concurrente será medida mediante su correlación con la adaptación española del General Self Efficacy Scale de Baessler y Schwarzer. La fiabilidad del instrumento, así como de cada uno de los factores, será determinada utilizando el coeficiente alfa de Cronbach de consistencia interna. Dos semanas más tarde, la escala será administrada a, al menos, un tercio de la muestra para obtener una fiabilidad test-retest y para permitir un análisis factorial confirmatorio.Resultados: Se espera diseñar, construir y validar un cuestionario que permita producir dos tipos de medidas: una valoración especifica la auto-eficacia percibida en el manejo de la enfermedad celíaca, y una valoración de la auto-eficacia para cada una de las áreas clave identificadas. Esta investigación proporcionará la primera escala para evaluar la autoeficacia específica para la adherencia a la dieta sin gluten de importante utilidad en entornos tanto clínicos como de investigación. Se prevé que su valor predictivo sea superior a medidas generales de la expectativa de autoeficacia.Conclusiones: Este cuestionario será el primero capaz de determinar los niveles de auto-eficacia en la adherencia a la dieta libre de gluten y ayudará en el diseño de intervenciones de auto-cuidado para pacientes celíacos

Social support as a mediator in the relationship between technostress or academic stress and health: analysis by gender among university students

IntroductionThis research aims to study the role of social support as a mediator in the relationship between technostress or academic stress and health in university students.MethodsA descriptive, quantitative cross-sectional study has been carried out through a self-reported survey answered by 389 students during March and April 2022. The current level of health was the outcome variable. Technostress and academic stress were the criterion variables. Perceived social support was the mediator variable. The sociodemographic variables and ICT use at the educational level were the independent variables.ResultsWomen have higher levels of technostress and academic stress than men. Social support significantly and positively mediates the relationship between academic stress and self-perceived health in men.DiscussionThere is a clear need to develop new social management strategies that assist students in developing stable and long-lasting social networks, which can reduce stress during the student period and provide personal tools for later working life

Novel nickel nanoparticles stabilized by imidazolium-amidinate ligands for selective hydrogenation of alkynes

[EN] The main challenge in the hydrogenation of alkynes into (E)- or (Z)-alkenes is to control the selective formation of the alkene, avoiding the over-reduction to the corresponding alkane. In addition, the preparation of recoverable and reusable catalysts is of high interest. In this work, we report novel nickel nanoparticles (Ni NPs) stabilized by three different imidazolium-amidinate ligands (ICy center dot(NCN)-N-(Ar); L1: Ar = p-tol, L2: Ar = p-anisyl and L3: Ar = p-ClC6H4). The as-prepared Ni NPs were fully characterized by (HR)-TEM, XRD, WASX, XPS and VSM. The nanocatalysts are active in the hydrogenation of various substrates. They present a remarkable selectivity in the hydrogenation of alkynes towards (Z)-alkenes, particularly in the hydrogenation of 3-hexyne into (Z)-3-hexene under mild reaction conditions (room temperature, 3% mol Ni and 1 bar H-2). The catalytic behaviour of Ni NPs was influenced by the electron donor/acceptor groups (-Me, -OMe, -Cl) in the N-aryl substituents of the amidinate moiety of the ligands. Due to the magnetic character of the Ni NPs, recycling experiments were successfully performed after decantation in the presence of an external magnet, which allowed us to recover and reuse these catalysts at least 3 times preserving both activity and chemoselectivity.The authors thank CNRS, UPS-Toulouse, INSA, "IDEX/Chaires d'attractivite l'Universite Federale Toulouse Midi-Pyrenees", "Instituto de Tecnologia Quimica" (ITQ; UPV-CSIC), "Juan de la Cierva" programme (IJCI-2016-27966), "Primero Proyectos de Investigacion" (PAID-06-18), "Instituto de Investigaciones Quimicas" (IIQ; CSIC-US), "Ministerio de Ciencia, Innovacion y Universidades" (MCIU/AEI), FEDER funds of the European Union (PGC2018-095768-B-I00) and ERC Advanced Grant (MONACAT 2015-694159) for financial support. We also thank L. Datas for the TEM facilities (UMS Castaing) and S. Cayez for the HRTEM measurements.López-Vinasco, AM.; Martínez-Prieto, LM.; Asensio, JM.; Lecante, P.; Chaudret, B.; Cámpora, J.; Van Leeuwen, PWNM. (2020). Novel nickel nanoparticles stabilized by imidazolium-amidinate ligands for selective hydrogenation of alkynes. Catalysis Science & Technology. 10(2):342-350. https://doi.org/10.1039/c9cy02172hS342350102Swamy, K. C. K., Reddy, A. S., Sandeep, K., & Kalyani, A. (2018). Advances in chemoselective and/or stereoselective semihydrogenation of alkynes. Tetrahedron Letters, 59(5), 419-429. doi:10.1016/j.tetlet.2017.12.057Lei, J., Su, L., Zeng, K., Chen, T., Qiu, R., Zhou, Y., … Yin, S.-F. (2017). Recent advances of catalytic processes on the transformation of alkynes into functional compounds. Chemical Engineering Science, 171, 404-425. doi:10.1016/j.ces.2017.05.021J. G. de Vries and C. 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Prevalence of celiac disease in primary care: the need for its own code

Background: Celiac disease (CD) is an autoimmune chronic enteropathy of the small intestine caused by exposure to gluten in genetically predisposed individuals. CD is not easy to diagnose due to its unspecific symptomatology, especially in adults, a diagnosed/undiagnosed ratio of 1:7 is estimated. CD does not have its own code in the International Classification of Primary Care (ICPC) but it is coded under code D99 “Disease digestive system, other”, which hinders diagnosis, intervention and research. The aim of this study is to investigate the prevalence of CD in Arago´n, Spain, using the information available from Primary Care, as well as to discuss the difficulties involved in determining prevalence of CD from data collected at this level of medical intervention. Methods: We designed an epidemiological cross-sectional study and analysed 26,964 electronic clinical records from the Aragonese Health Service under code ICPC D99 collected up to December 31st, 2016. The clinical records were classified by their editable field “descriptor” according to their probability of being related to CD. Analyses of gender, age, age at diagnosis, province and health sector were carried out. Results: We found 4534 clinical records under 293 different descriptors with a high probability of referring to CD. Prevalence in Arago´n was estimated to be 0.35% ranging from 0.24 to 0.81% with important differences among health sectors. Conclusions: The prevalence of 0.35% is a long way from the generally accepted 1% but within the usually considered ratio 1:7 of diagnosed:undiagnosed cases. Differences among sectors should be carefully analysed. Lacking its own ICPC code, diagnosis of CD in Primary Care Services is not included in a single category, but it is distributed under several descriptors, which makes it difficult to offer any firm diagnosis for treatment and hinders research. Finally, the high prevalence of CD justifies its own ICPC code and the need to withdraw CD from the generic D99 code “Disease digestive system other”

Health-care users, key community informants and primary health care workers' views on health, health promotion, health assets and deficits : qualitative study in seven Spanish regions

Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention. A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out. Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having implemented some change to promote their health. The most powerful motivators to change lifestyles are having a disease, fear of becoming ill and taking care of oneself to maintain health. Health-care users believe that the main difficulties are associated with the physical, social, working and family environment, as well as lack of determination and motivation. They also highlight the need for more information. In relation to the assets and deficits of the neighbourhood, each group identifies those closer to their role. Generally, participants showed a holistic and positive concept of health and a more traditional, individual approach to health promotion. We consider therefore crucial to depart from the model of health services that focuses on the individual and the disease toward a socio-ecological health model that substantially increases the participation of health-care users and emphasizes health promotion, wellbeing and community participation

Beyond the consultation room : Proposals to approach health promotion in primary care according to health-care users, key community informants and primary care centre workers

Primary health care () is the ideal setting to provide integrated services centred on the person and to implement health promotion () activities. To identify proposals to approach in the context of primary care according to health-care users aged 45-75 years, key community informants and primary care centre () workers. Descriptive-interpretive qualitative research with 276 participants from 14 of seven Spanish regions. A theoretical sampling was used for selection. A total of 25 discussion groups, two triangular groups and 30 semi-structured interviews were carried out. A thematic interpretive contents analysis was carried out. Participants consider that is not solely a matter for the health sector and they emphasize intersectoral collaboration. They believe that it is important to strengthen community initiatives and to create a healthy social environment that encourages greater responsibility and participation of health-care users in decisions regarding their own health and better management of public services and resources. , care in the community and demedicalization should be priorities for . Participants propose organizational changes in the to improve . workers are aware that falls within the scope of their responsibilities and propose to increase their training, motivation, competences and knowledge of the social environment. Informants emphasize that should be person-centred approach and empathic communication. activities should be appealing, ludic and of proven effectiveness. According to a socio-ecological and intersectoral model, services must get actively involved in together with community and through outreach interventions

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections