Ertapenem for the treatment of bloodstream infections due to ESBL-producing Enterobacteriaceae: A multinational pre-registered cohort study
Journal
Journal of Antimicrobial Chemotherapy
Journal Volume
71
Journal Issue
6
Pages
1672-1680
Date Issued
2016
Author(s)
Guti?rrez-Guti?rrez B.
Bonomo R.A.
Carmeli Y.
Paterson D.L.
Almirante B.
Mart?nez-Mart?nez L.
Oliver A.
Calbo E.
Pe?a C.
Akova M.
Pitout J.
Orig?en J.
Pintado V.
Garc?a-V?zquez E.
Gasch O.
Hamprecht A.
Prim N.
Tumbarello M.
Bou G.
Viale P.
Tacconelli E.
Almela M.
P?rez F.
Giamarellou H.
Cisneros J.M.
Schwaber M.J.
Venditti M.
Lowman W.
Bermejo J.
Mora-Rillo M.
Gracia-Ahulfinger I.
Pascual A.
Rodr?guez-Ba?o J.
Karaiskos I.
Trecarichi E.M.
Losito A.R.
Hern?ndez A.
G?mez J.
Navarro F.
Mirelis B.
Larrosa N.
Puig M.
Rucci V.
Bartoletti M.
Giannella M.
Riemenschneider F.
Badia C.
Xercavins M.
G?lvez J.
de Cueto M.
Salamanca E.
Falcone M.
Russo A.
Daikos G.
Roilides E.
Iosifidis E.
Doi Y.
Tuon F.F.
San Juan R.
Fern?ndez-Ruiz M.
Molina J.
Gonz?lez V.
Ruiz de Gopegui E.
Marinescu C.I.
Fari?as M.C.
Cano M.E.
Gozalo M.
Pa?o-Pardo J.R.
Navarro-San Francisco C.
G?mez-Zorrilla S.
Tubau F.
Pournaras S.
Tsakris A.
Zarkotou O.
Azap ?.K.
Souli M.
Antoniadou A.
Poulakou G.
Virmani D.
Machuca I.
P?rez-Nadales E.
Torre-Cisneros J.
Helvaci ?.
Sahin A.O.
Cant?n R.
Ruiz P.
Fontanals D.
Jov? E.
REIPI/ESGBIS/INCREMENT Group
Abstract
Objectives: Data about the efficacy of ertapenem for the treatment of bloodstream infections (BSI) due to ESBL-producing Enterobacteriaceae (ESBL-E) are limited. We compared the clinical efficacy of ertapenem and other carbapenems in monomicrobial BSI due to ESBL-E. Methods: A multinational retrospective cohort study (INCREMENT project) was performed (ClinicalTrials.gov identifier: NCT01764490). Patients given monotherapy with ertapenem or other carbapenems were compared. Empirical and targeted therapies were analysed. Propensity scores were used to control for confounding; sensitivity analyses were performed in subgroups. The outcome variables were cure/improvement rate at day 14 and all-cause 30 day mortality. Results: The empirical therapy cohort (ETC) and the targeted therapy cohort (TTC) included 195 and 509 patients, respectively. Cure/improvement rateswere 90.6% with ertapenem and 75.5% with other carbapenems (P=0.06) in the ETC and 89.8% and 82.6% (P=0.02) in the TTC, respectively; 30 day mortality rates were 3.1% and 23.3% (P=0.01) in the ETC and 9.3% and 17.1% (P=0.01) in the TTC, respectively. Adjusted ORs (95% CI) for cure/improvement with empirical and targeted ertapenem were 1.87 (0.24-20.08; P=0.58) and 1.04 (0.44- 2.50; P=0.92), respectively. For the propensity-matched cohorts it was 1.18 (0.43-3.29; P=0.74). Regarding 30 day mortality, the adjusted HR (95% CI) for targeted ertapenem was 0.93 (0.43-2.03; P=0.86) and for the propensity-matched cohorts it was 1.05 (0.46-2.44; P=0.90). Sensitivity analyses were consistent except for patients with severe sepsis/septic shock, which showed a non-significant trend favouring other carbapenems. Conclusions: Ertapenem appears as effective as other carbapenems for empirical and targeted therapy of BSI due to ESBL-E, but further studies are needed for patients with severe sepsis/septic shock. ? The Author 2016.
SDGs
Other Subjects
doripenem; ertapenem; imipenem; meropenem; antiinfective agent; beta lactam; beta lactamase; carbapenem derivative; ertapenem; adult; aged; Article; bloodstream infection; cohort analysis; controlled clinical trial; controlled study; drug efficacy; Enterobacteriaceae infection; extended spectrum beta lactamase producing Enterobacteriaceae; female; general condition improvement; human; major clinical study; male; monotherapy; mortality rate; multicenter study; propensity score; retrospective study; sensitivity analysis; treatment outcome; very elderly; clinical trial; comparative study; Enterobacteriaceae; Enterobacteriaceae Infections; enzymology; isolation and purification; microbiology; middle aged; secretion (process); sepsis; survival analysis; Aged; Anti-Bacterial Agents; beta-Lactamases; beta-Lactams; Carbapenems; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Retrospective Studies; Sepsis; Survival Analysis; Treatment Outcome
Type
journal article