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

Mario Tumbarello, Evelina Tacconelli, Enrico Maria Trecarichi, Angela Raffaella Losito, Belén Gutiérrez-Gutiérrez, Robert A. Bonomo, Yehuda Carmeli, David L. Paterson, Benito Almirante, Luis Martínez-Martínez, Antonio Oliver, Esther Calbo, Carmen Peña, Murat Akova, Johann Pitout, Julia Origüen, Vicente Pintado, Elisa García-Vázquez, Oriol Gasch, Axel HamprechtNuria Prim, German Bou, Pierluigi Viale, Manel Almela, Federico Pérez, Helen Giamarellou, José Miguel Cisneros, Mitchell J. Schwaber, Mario Venditti, Warren Lowman, Joaquín Bermejo, Po-Ren Hsueh, Marta Mora-Rillo, Irene Gracia-Ahulfinger, Alvaro Pascual, Jesús Rodríguez-Baño, I. Karaiskos, A. Hernández, J. Gómez, F. Navarro, B. Mirelis, N. Larrosa, M. Puig, V. Rucci, M. Bartoletti, M. Giannella, F. Riemenschneider, C. Badia, M. Xercavins, J. Gálvez, M. De Cueto, E. Salamanca, M. Falcone, A. Russo, G. Daikos, E. Roilides, E. Iosifidis, Y. Doi, F. F. Tuon, R. San Juan, M. Fernández-Ruiz, J. Molina, V. González, E. Ruiz De Gopegui, C. I. Marinescu, M. C. Fariñas, M. E. Cano, M. Gozalo, J. R. Paño-Pardo, C. Navarro-San Francisco, S. Gómez-Zorrilla, F. Tubau, S. Pournaras, A. Tsakris, O. Zarkotou, K. Azap, M. Souli, A. Antoniadou, G. Poulakou, D. Virmani, I. Machuca, E. Pérez-Nadales, J. Torre-Cisneros, Helvaci, A. O. Sahin, R. Cantón, P. Ruiz, D. Fontanals, E. Jové

Risultato della ricerca: Contributo in rivistaArticolo in rivista

29 Citazioni (Scopus)

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.
Lingua originaleEnglish
pagine (da-a)1672-1680
Numero di pagine9
RivistaJournal of Antimicrobial Chemotherapy
Volume71
DOI
Stato di pubblicazionePubblicato - 2016

Keywords

  • Infectious Diseases
  • Pharmacology
  • Pharmacology (medical)

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