Clinical experience with ertapenem in the treatment of infections of the biliary tract in daily practice in five Spanish hospitals

Abstract

Efficacy of ertapenem in biliary tract infections in daily practice was retrospectively analyzed. Records of patients admitted to five Spanish hospitals (January 2007/February 2011) with biliary infections (cholecystitis/cholangitis) treated with ertapenem for ≥72 hours were reviewed. A total of 187 patients (mean 63.8±19.3 years, 52.9% males) were identified. Up to 96 (51.3%) were operated, with cholecystectomy (97.9%) and primary laparoscopy approach (75%) as most frequent intervention. Non-operated patients presented higher age (71.0±17.5 vs 56.9±18.5 years; P<0.001), heart insufficiency (11.0 vs 3.1%; P = 0.044) and the Mortality in Emergency Department Sepsis score (2.99±2.26 vs 1.94±2.34; P<0.001); and longer length of stay (10.3±6.6 vs 9.1±7.0; P = 0.005). Mean duration of treatment was 6.89±3.38 days. Overall favourable response was 87.7% (95% CI = 83.0-92.4) at the end of treatment. In the multivariate analysis (P<0.001, R² Cox = 0.10), non-favourable response was associated with Charlson index≥5 (OR = 18.71; 95% CI: 1.26-278.55; P = 0.034), pericholecystic abscess (OR = 5.30; 95% CI: 1.26-22.37; P = 0.023) and >3 days from symptoms start to admission (OR = 3.02; 95% CI: 1.13-8.04; P = 0.027).

Home hospitalization for the surgical and conservative treatment of acute calculous cholecystitis

“…A home care unit, usually comprised of nurses and physicians, can visit the patient at home to complement the care provided by the caregiver. Availability of onceor twice-daily antibiotics and easy-to-use continuous perfusion pumps, 13,14 as well as the use of the laparoscopic approach in cholecystectomy, allows for shortened inpatient stays and even avoidance of hospital admissions. In Spain, it was first implemented in 1981 by Gregorio Marañon Hospital.…”

“…For patients with acute cholecystitis, home hospitalization can be a valid option for completing the hospital treatment, such as parenteral antibiotherapy and/or wound care and drainage control after open or laparoscopic cholecystectomy. Availability of once‐ or twice‐daily antibiotics and easy‐to‐use continuous perfusion pumps, as well as the use of the laparoscopic approach in cholecystectomy, allows for shortened inpatient stays and even avoidance of hospital admissions . At the same time, home care offers patients increased psychological and physical comfort, and a decreased risk of nosocomial infections…”