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.
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: Belén Gutiérrez-Gutiérrez; Robert A Bonomo; Yehuda Carmeli; David L Paterson; Benito Almirante; Luis Martínez-Martínez; Antonio Oliver; Esther Calbo; Carmen Peña; Murat Akova; Johann Pitout; Julia Origüen; Vicente Pintado; Elisa García-Vázquez; Oriol Gasch; Axel Hamprecht; Nuria Prim; Mario Tumbarello; German Bou; Pierluigi Viale; Evelina Tacconelli; Manel Almela; Federico Pérez; Helen Giamarellou; José Miguel Cisneros; Mitchell J Schwaber; Mario Venditti; Warren Lowman; Joaquín Bermejo; Po-Ren Hsueh; Marta Mora-Rillo; Irene Gracia-Ahulfinger; Alvaro Pascual; Jesús Rodríguez-Baño Journal: J Antimicrob Chemother Date: 2016-02-22 Impact factor: 5.790
Authors: Belén Gutiérrez-Gutiérrez; Elena Pérez-Nadales; Salvador Pérez-Galera; Mario Fernández-Ruiz; Jordi Carratalà; Isabel Oriol; Elisa Cordero; José Antonio Lepe; Ban Hock Tan; Laura Corbella; Mical Paul; Alejandra M Natera; Miruna D David; Miguel Montejo; Ranganathan N Iyer; Ligia Camera Pierrotti; Esperanza Merino; Seema Mehta Steinke; Meenakshi M Rana; Patricia Muñoz; Alessandra Mularoni; Christian van Delden; Paolo Antonio Grossi; Elena María Seminari; Filiz Gunseren; Erika D Lease; Emmanuel Roilides; Jesús Fortún; Hande Arslan; Julien Coussement; Zeliha Koçak Tufan; Benoit Pilmis; Marco Rizzi; Belén Loeches; Britt Marie Eriksson; Edson Abdala; Fabio Soldani; Warren Lowman; Wanessa Trindade Clemente; Marta Bodro; María Carmen Fariñas; Esra Kazak; Luis Martínez-Martínez; José María Aguado; Julián Torre-Cisneros; Álvaro Pascual; Jesús Rodríguez-Baño Journal: Antimicrob Agents Chemother Date: 2021-08-09 Impact factor: 5.191