Efficacy of ertapenem in the treatment of early ventilator-associated pneumonia caused by extended-spectrum beta-lactamase-producing organisms in an intensive care unit.
OBJECTIVE
Ventilator-associated pneumonia (VAP) is a frequent complication of patients admitted to intensive care units (ICUs). Ertapenem is a newer carbapenem with good in vitro activity against extended-spectrum beta-lactamase (ESBL)-producing organisms. However, there are no clinical data to support the use of ertapenem in VAP. Our purpose is to evaluate the usefulness and safety of ertapenem in the treatment of VAP caused by susceptible ESBL strains.


METHODS
Ertapenem 1 g daily intravenously was given to adult patients with signs and symptoms of VAP beginning within 7 days of mechanical ventilation and caused by ESBL-producing Gram-negative organisms.


RESULTS
From June 2005 to June 2006, we enrolled 20 adult patients hospitalized in an ICU and diagnosed with VAP due to Gram-negative ESBL strains. Causative organisms identified as ESBL producers susceptible to ertapenem were Klebsiella pneumoniae (alone in 10 cases and with methicillin-resistant Staphylococcus aureus in 4 cases), Enterobacter cloacae (2), Proteus mirabilis (2) and Citrobacter freundii (2). Clinical success was achieved in 16/20 (80%) of the clinically evaluable patients and in 15/20 (75%) of the microbiologically evaluable patients. The drug was well-tolerated; one patient presented a transient increase in liver enzymes.


CONCLUSIONS
We believe this is one of the first reports to demonstrate that ertapenem has clinical utility in treating serious infections caused by ESBL-producing organisms. Ertapenem appears to be suitable for ESBL VAP therapy. This pilot study suggests subsequent controlled randomized trials in this indication.
Bassetti
Matteo
M
Infectious Diseases Division, San Martino University Hospital, Genoa, Italy. mattba@tin.it
Righi
Elda
E
Fasce
Roberta
R
Molinari
Maria Pia
MP
Rosso
Raffaella
R
Di Biagio
Antonio
A
Mussap
Michele
M
Pallavicini
Franco Bobbio
FB
Viscoli
Claudio
C
D018806:APACHE; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects; D000077727:Ertapenem; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008099:Liver / Q000187:drug effects / Q000201:enzymology; D008297:Male; D008826:Microbial Sensitivity Tests; D010865:Pilot Projects; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology*; D011446:Prospective Studies; D001618:beta-Lactamases / Q000378:metabolism*; D047090:beta-Lactams / Q000009:adverse effects / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D001618:beta-Lactamases; D000077727:Ertapenem