Ertapenem for treatment of extended-spectrum beta-lactamase-producing and multidrug-resistant gram-negative bacteraemia

Abstract

Introduction: Imipenem and meropenem are treatment of choice for extended-spectrum beta-lactamase (ESBL)-positive gram-negative bacteraemia. They may select for carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa; ertapenem may not do so as it is inactive against these bacteria. Clinical efficacy of ertapenem in ESBL-producing gram-negative bacteraemia is limited. Materials and Methods: Retrospective study of patients with ESBL-positive gram-negative bacteraemia treated with ertapenem was undertaken. Results: Forty-seven patients with multidrug-resistant gram-negative bacteraemia (79% produced ESBL) were treated with ertapenem for a median duration of 11 days. The median age was 70 years. Septic shock occurred in 19% and mechanical ventilation was needed in 17%. Klebsiella pneumoniae comprised 53% and Escherichia coli 26%. Urinary infection accounted for 61% and hepatobiliary 15%. Favourable clinical response occurred in 96%. Attributable mortality was 4%. Conclusion: Ertapenem is promising in culture-guided step-down therapy of ESBL-positive gram-negative bacteraemia.