%0 Journal Article
%A Gutierrez-Gutierrez, Belen
%A Bonomo, Robert A
%A Carmeli, Yehuda
%A Paterson, David L
%A Almirante, Benito
%A Martinez-Martinez, Luis
%A Oliver, Antonio
%A Calbo, Esther
%A Peña, Carmen
%A Akova, Murat
%A Pitout, Johann
%A Origüen, Julia
%A Pintado, Vicente
%A Garcia-Vazquez, Elisa
%A Gasch, Oriol
%A Hamprecht, Axel
%A Prim, Nuria
%A Tumbarello, Mario
%A Bou, German
%A Viale, Pierluigi
%A Tacconelli, Evelina
%A Almela, Manel
%A Perez, Federico
%A Giamarellou, Helen
%A Cisneros, Jose Miguel
%A Schwaber, Mitchell J
%A Venditti, Mario
%A Lowman, Warren
%A Bermejo, Joaquin
%A Hsueh, Po-Ren
%A Mora-Rillo, Marta
%A Gracia-Ahulfinger, Irene
%A Pascual, Alvaro
%A Rodriguez-Baño, Jesus
%T Ertapenem for the treatment of bloodstream infections due to ESBL-producing Enterobacteriaceae: a multinational pre-registered cohort study.
%D 2015
%U http://hdl.handle.net/10668/9859
%X Data about the efficacy of ertapenem for the treatment of bloodstream infections (BSI) due to ESBL-producing Enterobacteriaceae (ESBL-E) are limited. We compared the clinical efficacy of ertapenem and other carbapenems in monomicrobial BSI due to ESBL-E. A multinational retrospective cohort study (INCREMENT project) was performed (ClinicalTrials.gov identifier: NCT01764490). Patients given monotherapy with ertapenem or other carbapenems were compared. Empirical and targeted therapies were analysed. Propensity scores were used to control for confounding; sensitivity analyses were performed in subgroups. The outcome variables were cure/improvement rate at day 14 and all-cause 30 day mortality. The empirical therapy cohort (ETC) and the targeted therapy cohort (TTC) included 195 and 509 patients, respectively. Cure/improvement rates were 90.6% with ertapenem and 75.5% with other carbapenems (P = 0.06) in the ETC and 89.8% and 82.6% (P = 0.02) in the TTC, respectively; 30 day mortality rates were 3.1% and 23.3% (P = 0.01) in the ETC and 9.3% and 17.1% (P = 0.01) in the TTC, respectively. Adjusted ORs (95% CI) for cure/improvement with empirical and targeted ertapenem were 1.87 (0.24-20.08; P = 0.58) and 1.04 (0.44-2.50; P = 0.92), respectively. For the propensity-matched cohorts it was 1.18 (0.43-3.29; P = 0.74). Regarding 30 day mortality, the adjusted HR (95% CI) for targeted ertapenem was 0.93 (0.43-2.03; P = 0.86) and for the propensity-matched cohorts it was 1.05 (0.46-2.44; P = 0.90). Sensitivity analyses were consistent except for patients with severe sepsis/septic shock, which showed a non-significant trend favouring other carbapenems. Ertapenem appears as effective as other carbapenems for empirical and targeted therapy of BSI due to ESBL-E, but further studies are needed for patients with severe sepsis/septic shock.
%K Anti-bacterial agents
%K Carbapenems
%K Enterobacteriaceae
%K Enterobacteriaceae infections
%~