@article{3022387,
    title = "Ertapenem for the treatment of bloodstream infections due to ESBL-producing Enterobacteriaceae: A multinational pre-registered cohort study",
    author = "Gutiérrez-Gutiérrez, B. and Bonomo, R.A. and Carmeli, Y. and Paterson, D.L. and Almirante, B. and Martínez-Martínez, L. and Oliver, A. and Calbo, E. and Peña, C. and Akova, M. and Pitout, J. and Origüen, J. and Pintado, V. and García-Vázquez, E. and Gasch, O. and Hamprecht, A. and Prim, N. and Tumbarello, M. and Bou, G. and Viale, P. and Tacconelli, E. and Almela, M. and Pérez, F. and Giamarellou, H. and Cisneros, J.M. and Schwaber, M.J. and Venditti, M. and Lowman, W. and Bermejo, J. and Hsueh, P.-R. and Mora-Rillo, M. and Gracia-Ahulfinger, I. and Pascual, A. and Rodríguez-Baño, J. and Karaiskos, I. and Trecarichi, E.M. and Losito, A.R. and Hernández, A. and Gómez, J. and Navarro, F. and Mirelis, B. and Larrosa, N. and Puig, M. and Rucci, V. and Bartoletti, M. and Giannella, M. and Riemenschneider, F. and Badia, C. and Xercavins, M. and Gálvez, J. and de Cueto, M. and Salamanca, E. and Falcone, M. and Russo, A. and Daikos, G. and Roilides, E. and Iosifidis, E. and Doi, Y. and Tuon, F.F. and San Juan, R. and Fernández-Ruiz, M. and Molina, J. and González, V. and Ruiz de Gopegui, E. and Marinescu, C.I. and Fariñas, M.C. and Cano, M.E. and Gozalo, M. and Paño-Pardo, J.R. and Navarro-San Francisco, C. and Gómez-Zorrilla, S. and Tubau, F. and Pournaras, S. and Tsakris, A. and Zarkotou, O. and Azap, Ö.K. and Souli, M. and Antoniadou, A. and Poulakou, G. and Virmani, D. and Machuca, I. and Pérez-Nadales, E. and Torre-Cisneros, J. and Helvaci, Ö. and Sahin, A.O. and Cantón, R. and Ruiz, P. and Fontanals, D. and Jové, E. and REIPI/ESGBIS/INCREMENT Group",
    journal = "The Journal of antimicrobial chemotherapy",
    year = "2016",
    volume = "71",
    number = "6",
    pages = "1672-1680",
    publisher = "Oxford University Press",
    doi = "10.1093/jac/dkv502",
    keywords = "doripenem;  ertapenem;  imipenem;  meropenem;  antiinfective agent;  beta lactam;  beta lactamase;  carbapenem derivative;  ertapenem, adult;  aged;  Article;  bloodstream infection;  cohort analysis;  controlled clinical trial;  controlled study;  drug efficacy;  Enterobacteriaceae infection;  extended spectrum beta lactamase producing Enterobacteriaceae;  female;  general condition improvement;  human;  major clinical study;  male;  monotherapy;  mortality rate;  multicenter study;  propensity score;  retrospective study;  sensitivity analysis;  treatment outcome;  very elderly;  clinical trial;  comparative study;  Enterobacteriaceae;  Enterobacteriaceae Infections;  enzymology;  isolation and purification;  microbiology;  middle aged;  secretion (process);  sepsis;  survival analysis, Aged;  Anti-Bacterial Agents;  beta-Lactamases;  beta-Lactams;  Carbapenems;  Enterobacteriaceae;  Enterobacteriaceae Infections;  Female;  Humans;  Male;  Middle Aged;  Retrospective Studies;  Sepsis;  Survival Analysis;  Treatment Outcome",
    abstract = "Objectives: 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. Methods: 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. Results: The empirical therapy cohort (ETC) and the targeted therapy cohort (TTC) included 195 and 509 patients, respectively. Cure/improvement rateswere 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. Conclusions: 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. © The Author 2016."
}