Ερευνητικό υλικό ΕΚΠΑ

Ertapenem for the treatment of bloodstream infections due to ESBL-producing Enterobacteriaceae: A multinational pre-registered cohort study

Αγγλικά

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.

2016

Gutiérrez-Gutiérrez, B.
Bonomo, R.A.
Carmeli, Y.
Paterson, D.L.
Almirante, B.
Martínez-Martínez, L.
Oliver, A.
Calbo, E.
Peña, C.
Akova, M.
Pitout, J.
Origüen, J.
Pintado, V.
García-Vázquez, E.
Gasch, O.
Hamprecht, A.
Prim, N.
Tumbarello, M.
Bou, G.
Viale, P.
Tacconelli, E.
Almela, M.
Pérez, F.
Giamarellou, H.
Cisneros, J.M.
Schwaber, M.J.
Venditti, M.
Lowman, W.
Bermejo, J.
Hsueh, P.-R.
Mora-Rillo, M.
Gracia-Ahulfinger, I.
Pascual, A.
Rodríguez-Baño, J.
Karaiskos, I.
Trecarichi, E.M.
Losito, A.R.
Hernández, A.
Gómez, J.
Navarro, F.
Mirelis, B.
Larrosa, N.
Puig, M.
Rucci, V.
Bartoletti, M.
Giannella, M.
Riemenschneider, F.
Badia, C.
Xercavins, M.
Gálvez, J.
de Cueto, M.
Salamanca, E.
Falcone, M.
Russo, A.
Daikos, G.
Roilides, E.
Iosifidis, E.
Doi, Y.
Tuon, F.F.
San Juan, R.
Fernández-Ruiz, M.
Molina, J.
González, V.
Ruiz de Gopegui, E.
Marinescu, C.I.
Fariñas, M.C.
Cano, M.E.
Gozalo, M.
Paño-Pardo, J.R.
Navarro-San Francisco, C.
Gómez-Zorrilla, S.
Tubau, F.
Pournaras, S.
Tsakris, A.
Zarkotou, O.
Azap, Ö.K.
Souli, M.
Antoniadou, A.
Poulakou, G.
Virmani, D.
Machuca, I.
Pérez-Nadales, E.
Torre-Cisneros, J.
Helvaci, Ö.
Sahin, A.O.
Cantón, R.
Ruiz, P.
Fontanals, D.
Jové, E.
REIPI/ESGBIS/INCREMENT Group

The Journal of antimicrobial chemotherapy

Oxford University Press

71

6

1672-1680

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

https://doi.org/10.1093/jac/dkv502

10.1093/jac/dkv502

https://pergamos.lib.uoa.gr/uoa/dl/object/3022387