title: Ertapenem in the treatment of bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli: a propensity score analysis.
abstract: OBJECTIVE
  This study assessed the impact of ertapenem and other carbapenems on mortality in patients with monomicrobial extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) bacteremia.
  
  
  METHODS
  This non-concurrent prospective study included adult patients with ESBL-EC bacteremia during a 2.5-year period at a 2200-bed teaching hospital. We used a multivariate logistic regression model and Cox's proportional hazards model including propensity score analysis to assess variables associated with 30-day mortality.
  
  
  RESULTS
  Of 71 patients who met the study criteria, nine died within 3 days. Among the 62 remaining patients who received definitive antimicrobial therapy, 13 died within 30 days. Male gender, ICU stay, solid tumor, and primary bacteremia were independent predictors of 30-day mortality, whereas definitive antimicrobial therapy using either ertapenem or imipenem/meropenem was protective (p<0.001 and p=0.002, respectively). Adjustment by propensity score found that ertapenem appeared to exhibit more favorable outcomes, but the difference fell short of statistical significance (hazard ratio 0.02, p=0.06). Inappropriate initial therapy was not a significant predictor of mortality.
  
  
  CONCLUSIONS
  ICU stay, but not initial choice of empirical antimicrobial therapy, was a major predictor of mortality. Using a carbapenem as definitive therapy was a protective factor for 30-day mortality. The choice of ertapenem is reasonable for less severely-ill patients who are at risk of ESBL-EC bacteremia and unlikely to have infection due to Pseudomonas aeruginosa.
authors: Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, 100, Taiwan.
authors: Un-In
authors: UI
authors: Wu
authors: Wan-Chin
authors: WC
authors: Chen
authors: Ching-Shiang
authors: CS
authors: Yang
authors: Jiun-Ling
authors: JL
authors: Wang
authors: Fu-Chang
authors: FC
authors: Hu
authors: Shan-Chwen
authors: SC
authors: Chang
authors: Yee-Chun
authors: YC
authors: Chen
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality*; D015780:Carbapenems / Q000494:pharmacology; D000077727:Ertapenem; D004926:Escherichia coli / Q000302:isolation & purification / Q000472:pathogenicity*; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D057216:Propensity Score; D013845:Thienamycins / Q000627:therapeutic use; D001618:beta-Lactamases / Q000096:biosynthesis; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D013845:Thienamycins; D047090:beta-Lactams; D015378:Imipenem; D001618:beta-Lactamases; D000077731:Meropenem; D000077727:Ertapenem