1023. Thrice is Nice: Thrice Weekly Ertapenem Versus Daily Ertapenem in Patients on Hemodialysis

Abstract

Background Outpatient parenteral antimicrobial therapy (OPAT) has challenges: venous access complications, cost, and non-adherence. Venous line preservation is an added concern for patients on hemodialysis (HD). While ertapenem is dosed 500 mg daily post-HD, there is limited data on dosing it as 1 gm thrice weekly. This study compares disposition and outcome in patients treated with these two regimens. Methods IRB approved, retrospective cohort study. Inclusion: adult patients on intermittent HD, admitted 6/1/20 to 7/31/21, and discharged with ertapenem either with daily (daily group) or thrice weekly (TIW group) dosing. Data were reported using descriptive statistics and bivariate analysis. Primary endpoints: discharge delay after medical stability. Secondary endpoints: efficacy (readmissions, alterations in antibiotics, and mortality) and safety (line or drug – related adverse events including line infection and seizure). Results 33 patients included: 10 daily and 23 TIW. Baseline characteristics were similar. Median (IQR) age: 57 (48-64) daily and 63 (47-70) TIW, P=0.552. Both groups had a high median Charlson index (IQR): 5 (4-5) daily and 4 (2-5) TIW, P=0.287. Primary reason for ertapenem use was infection from extended-spectrum beta lactamase producing organism: 60% daily and 52% TIW. The TIW group had significantly fewer lines placed (80% daily vs. 22% TIW, p=0.05). Median (IQR) length of stay in days was similar: 7 (6–15) daily and 8 (6-8) TIW, P=0.773. Discharge delays were similar (10% daily vs 9% TIW, P=1.0). Most patients were discharged home (60%). More patients received ertapenem at the dialysis center or infusion clinic in the TIW group (78% TIW vs 30% daily, P=0.016). There was no difference in safety and efficacy endpoints including readmission, mortality, alternation in antibiotics, and line infection. Conclusion In this study’s cohort, ertapenem thrice weekly dosing led to a decrease in line placement without compromising efficacy and safety. Disclosures All Authors: No reported disclosures.