Ertapenem in the treatment of bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli: a propensity score analysis

Wu, Un‐In; Chen, Wan-Chin; Yang, Ching Wen; Wang, Jiun‐Ling; Hu, Fang; Chang, Shan Chwen; Chen, Yee‐Chun

doi:10.1016/j.ijid.2011.09.019

Cited by 24 publications

(22 citation statements)

References 39 publications

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“…Among carbapenems, most studies evaluated imipenem or meropenem. There is also some recent experience with ertapenem [Collins et al 2012;Wu et al 2012]; this antibiotic would be preferred for empirical therapy in community-acquired severe infections potentially caused by ESBL producers when coverage against Pseudomonas aeruginosa or Acinetobacter baumannii is not needed to avoid further selection pressure over these organisms [Nicolau et al 2012], since ertapenem lacks significant activity against them. It may also be useful for outpatient parenteral therapy because of the convenience of once daily dosing.…”

Section: Carbapenemsmentioning

confidence: 99%

Clinical management of infections caused by multidrug-resistant Enterobacteriaceae

Delgado-Valverde

Sojo-Dorado

Pascual

2013

Therapeutic Advances in Infection

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Enterobacteriaceae showing resistance to cephalosporins due to extended-spectrum b-lactamases (ESBLs) or plasmid-mediated AmpC enzymes, and those producing carbapenemases have spread worldwide during the last decades. Many of these isolates are also resistant to other first-line agents such as fluoroquinolones or aminoglycosides, leaving few available options for therapy. Thus, older drugs such as colistin and fosfomycin are being increasingly used. Infections caused by these bacteria are associated with increased morbidity and mortality compared with those caused by their susceptible counterparts. Most of the evidence supporting the present recommendations is from in vitro data, animal studies, and observational studies. While carbapenems are considered the drugs of choice for ESBL and AmpC producers, recent data suggest that certain alternatives may be suitable for some types of infections. Combined therapy seems superior to monotherapy in the treatment of invasive infections caused by carbapenemase-producing Enterobacteriaceae. Optimization of dosage according to pharmacokinetics/pharmacodynamics data is important for the treatment of infections caused by isolates with borderline minimum inhibitory concentration due to lowlevel resistance mechanisms. The increasing frequency and the rapid spread of multidrug resistance among the Enterobacteriaceae is a true and complex public health problem. IntroductionThe traditional first-line available options for treating serious infections caused by enterobacteria include penicillins, cephalosporins, monobactams, carbapenems, fluorquinolones, and in certain situations, aminoglycosides. The frequency of resistance to these first-line agents has been rising worldwide during the last decades [Paterson 2006;Rhomberg and Jones 2009;Houghton et al. 2010;Nordmann, et al. 2011] and now reach high proportions in many areas of the world.

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Section: Carbapenemsmentioning

confidence: 99%

Clinical management of infections caused by multidrug-resistant Enterobacteriaceae

Delgado-Valverde

Sojo-Dorado

Pascual

2013

Therapeutic Advances in Infection

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“…When compared with antipseudomonal carbapenems, treatment with ertapenem for gram-negative primary bacteremia led to equivalent mortality rates and bacteriological eradication [26]. It was observed in our study that out of 57 treatment failure cases, ertapenem was used for bacteremia in 14 cases; of which, 8 were primary bacteremia cases.…”

Section: Discussionmentioning

confidence: 73%

Evaluation of Ertapenem use with Impact Assessment on Extended-Spectrum Beta-Lactamases (ESBL) Production and Gram-Negative resistance in Singapore General Hospital (SGH)

Lim

Lee

et al. 2013

BMC Infect Dis

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BackgroundErtapenem (preferred choice for ESBL-producing organisms) use exhibited an increasing trend from 2006 to 2008. As extensive use of ertapenem might induce the mutation of resistant bacteria strains to ertapenem, we aimed to assess the appropriateness and impact of ertapenem-use, on ESBL production, the trends of gram-negative bacterial resistance and on the utilization of other antibiotics in our institution.MethodsInpatients who received a dose of ertapenem during 1 January 2006 to 31 December 2008, were reviewed. Pertinent patient clinical data was extracted from the pharmacy databases and assessed for appropriateness based on dose and indication. Relevant data from Network for Antimicrobial Resistance Surveillance (Singapore) (NARSS) was extracted, to cross-correlate with ertapenem via time series to assess its impact on hospital epidemiology, trends of gram-negative resistance and consumption of other antibiotics from 2006 to mid-2010.Results906 cases were reviewed. Ertapenem therapy was appropriate in 72.4% (93.7% success rate). CNS adverse events were noted in 3.2%. Readmission rate (30-day) due to re-infection (same pathogen) was 5.5%. Fifty cases had cultures growing Pseudomonas aeruginosa within 30 days of ertapenem initiation, with 25 cases growing carbapenem-resistant Pseudomonas aeruginosa.Ertapenem use increased from 0.45 DDD/100 patient days in 2006 to 1.2 DDD/100 patient days in mid-2010. Overall, the increasing trend of ertapenem consumption correlated with 1) increasing incidence-densities of ciprofloxacin-resistant/cephalosporin-resistant E. coli at zero time lag; 2) increasing incidence-densities of ertapenem-resistant Escherichia. coli and Klebsiella spp. at zero time lag; 3) increasing incidence-density of carbapenem-resistant Pseudomonas aeruginosa, at zero time lag.Increasing ertapenem consumption was significantly correlated with decreasing consumption of cefepime (R2 = 0.37344) 3 months later. It was significantly correlated with a decrease in imipenem consumption (R2 = 0.31081), with no time lag but was correlated with subsequent increasing consumption of meropenem (R2 = 0.4092) 6 months later.ConclusionErtapenem use was appropriate. Increasing Ertapenem consumption did not result in a decreasing trend of ESBL producing enterobacteriaceae and could result in the selection for multi-drug resistant bacteria.

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“…Some reports have evaluated the efficacy of IV carbapenem-sparing antibiotics in this setting, including cephamycins, BL/BLIs or fluoroquinolones, and have presented both positive (5, 9, 12, 13, 23) and negative outcomes (24, 25). In a metanalysis (3), the use of empirical quinolones (oral or intravenous) for ESBL Enterobacteriaceae bacteremia was associated with a higher mortality than carbapenems, but mortality was similar when quinolones were used as definitive therapy.…”

Section: Discussionmentioning

confidence: 99%

Non-intravenous, carbapenem-sparing antibiotics for the treatment of bacteremia due to ESBL or AMP-C β-lactamase: A propensity score study

Meije¹,

Pigrau

Fernández-Hidalgo

et al. 2018

Preprint

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Introduction: Carbapenems are considered the treatment of choice for extended-spectrum β–lactamase (ESBL) or Amp-C β–lactamase-producing Enterobacteriaceae bacteremia. Data on the effectiveness of non-intravenous carbapenem-sparing antibiotic options are limited. Objective: To compare the 30 day-mortality and clinical failures associated with the use of carbapenems vs an alternative non-intravenous antibiotic for the definitive treatment of ESBL/Amp-C positive Enterobacteriaceae bacteremia. Methods: This is a 12-year retrospective study (2004 - 2015) including all patients with bacteremia due to ESBL/Amp-C-producing Enterobacteriaceae. Given the lack of randomization of the initial therapies, a propensity score for receiving carbapenems was calculated. Results: There were 1115 patients with a first episode of bacteremia due to E. coli or K. pneumoniae, of which 123 were ESBL/Amp C-positive (11%). There were 101 eligible patients: 59 in the carbapenem group and 42 in the alternative treatment group (cotrimoxazole 59.5%, quinolones 21.4%). The most frequent sources of infection were urinary (63%) and biliary (15%). Compared to the carbapenem group, patients treated with the alternative regimen had a shorter hospital stay (median [IQR]: 7 days [5-10] vs 12 days [9-18], p<0,001). The use of an alternative non-IV treatment did not increase mortality (OR 0.27; 95% CI 0.05-1.61; p=.15). After controlling for confounding factors with the propensity score, the adjusted OR of carbapenem treatment was 4.95; 95% CI (0.94-26.01, p=.059). Conclusion: Alternative non-IV carbapenem-sparing antibiotics could have a role in the definitive treatment of ESBL/Amp-C-positive Enterobacteriaceae bloodstream infections, allowing a reduction in carbapenem use. The use of cotrimoxazole in this setting has shown favourable results.

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Ertapenem in the treatment of bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli: a propensity score analysis

Cited by 24 publications

References 39 publications

Clinical management of infections caused by multidrug-resistant Enterobacteriaceae

Clinical management of infections caused by multidrug-resistant Enterobacteriaceae

Evaluation of Ertapenem use with Impact Assessment on Extended-Spectrum Beta-Lactamases (ESBL) Production and Gram-Negative resistance in Singapore General Hospital (SGH)

Non-intravenous, carbapenem-sparing antibiotics for the treatment of bacteremia due to ESBL or AMP-C β-lactamase: A propensity score study

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