Ertapenem for treatment of extended-spectrum beta-lactamase-producing and multidrug-resistant gram-negative bacteraemia.
BACKGROUND
Imipenem and meropenem are treatment of choice for extended-spectrum betalactamase (ESBL)-positive gram-negative bacteraemia. They may select for carbapenemresistant Acinetobacter baumannii and Pseudomonas aeruginosa; ertapenem may not do so as it is inactive against these bacteria. Clinical efficacy of ertapenem in ESBL-producing gramnegative bacteraemia is limited.


METHODS
Retrospective study of patients with ESBL-positive gram-negative bacteraemia treated with ertapenem was undertaken.


RESULTS
Forty-seven patients with multidrug-resistant gram-negative bacteraemia (79% produced ESBL) were treated with ertapenem for a median duration of 11 days. The median age was 70 years. Septic shock occurred in 19% and mechanical ventilation was needed in 17%. Klebsiella pneumoniae comprised 53% and Escherichia coli 26%. Urinary infection accounted for 61% and hepatobiliary 15%. Favourable clinical response occurred in 96%. Attributable mortality was 4%.


CONCLUSIONS
Ertapenem is promising in culture-guided step-down therapy of ESBL-positive gram-negative bacteraemia.
Lye
David Chien
DC
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore. david_lye@ttsh.com.sg
Wijaya
Limin
L
Chan
Joey
J
Teng
Chew Ping
CP
Leo
Yee Sin
YS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology; D024901:Drug Resistance, Multiple, Bacterial; D000077727:Ertapenem; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000201:enzymology; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy; D001618:beta-Lactamases / Q000096:biosynthesis; D047090:beta-Lactams / Q000494:pharmacology* / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D001618:beta-Lactamases; D000077727:Ertapenem