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Ertapenem for the treatment of bloodstream infections due to ESBL-producing Enterobacteriaceae: a multinational pre-registered cohort study

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Date
2015-12-26
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Authors
Gutiérrez-Gutiérrez, Belén ; Bonomo, Robert ; Carmel, Yehuda ; Paterson, David L. ; Almirante, Benito ; Martínez-Martínez, Luis ; Oliver, Antonio ; Calbo, Esther ; Peña, Carmen ; Akova, Murat ; Pitou, Johann ; Origüen, Julia ; Pintado, Vicente ; García-Vázquez, Elisa ; Gasch, Oriol ; Hamprecht, Axel ; Prim, Nuria ; Tumbarello, Mario ; Bou, German ; Viale, Pierluigi ; Tacconelli, Evelina ; Almela, Manel ; Pérez, Federico ; Giamarellou, Helen ; Cisneros, José Miguel ; Schwabe, Mitchell J. ; Venditti, Mario ; Lowman, Warren ; Bermejo, Joaquín ; Hsueh, Po-Ren ; Mora-Rillo, Marta ; Gracia-Ahulfinger, Irene ; Pascual, Álvaro ; Rodríguez-Baño, Jesús ; EIPI/ESGBIS/INCREMENT Group
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Publisher
Oxford University Press
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Medicina
DOI
https://doi.org/10.1093/jac/dkv502
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info:eu-repo/semantics/article
Description
©2016 The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. This document is the Published, version of a Published Work that appeared in final form in Journal of Antimicrobial Chemotherapy. To access the final edited and published work see https://doi.org/10.1093/jac/dkv502
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 rates were 90.6% with ertapenem and 75.5% with other carbapenems (P¼0.06) in the ETC and 89.8% and 82.6% (P ¼ 0.02) in the TTC, respectively; 30 day mortality rates were 3.1% and 23.3% (P¼0.01) in the ETC and 9.3% and 17.1% (P¼0.01) in the TTC, respectively. Adjusted ORs (95% CI) forcure/improvement with empirical and targeted ertapenem were 1.87 (0.24 – 20.08; P ¼0.58) and 1.04 (0.44 – 2.50; P ¼ 0.92), respectively. For the propensity-matched cohorts it was 1.18 (0.43 – 3.29; P¼ 0.74). Regarding 30 day mortality, the adjusted HR (95% CI) for targeted ertapenem was 0.93 (0.43 –2.03; P¼0.86) and for the propensity-matched cohorts it was 1.05 (0.46 – 2.44; P ¼0.90). 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
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Citation
Journal of Antimicrobial Chemotherapy 2016 71: 1672 –1680
URI
http://hdl.handle.net/10201/142719
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