Ertapenem in the treatment of bacteremia caused by extended-spectrum beta-lactamase-producing Escherichia coli: a propensity score analysis

• Published in: International journal of infectious diseases Vol. 16; no. 1; pp. e47 - e52
• Main Authors: Wu, Un-In, Chen, Wan-Chin, Yang, Ching-Shiang, Wang, Jiun-Ling, Hu, Fu-Chang, Chang, Shan-Chwen, Chen, Yee-Chun
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.01.2012
• Subjects: adults; Aged; Anti-Bacterial Agents - therapeutic use; Bacteremia; Bacteremia - drug therapy; Bacteremia - mortality; beta-Lactamases - biosynthesis; beta-Lactams - therapeutic use; Carbapenems - pharmacology; drug therapy; Ertapenem; ESBL; Escherichia coli; Escherichia coli - isolation & purification; Escherichia coli - pathogenicity; Female; Humans; imipenem; Imipenem - therapeutic use; Infectious Disease; Male; males; meropenem; Middle Aged; Mortality; patients; Propensity Score; prospective studies; Pseudomonas aeruginosa; Pulmonary/Respiratory; regression analysis; risk; Thienamycins - therapeutic use; ESBL; Ertapenem; Escherichia coli; Mortality; Bacteremia
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2011.09.019

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. 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. 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. 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.