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

Author(s): Lye DC, Wijaya L, Chan J, Teng CP, Leo YS

Affiliation(s): Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore. david_lye@ttsh.com.sg

Publication date & source: 2008-10, Ann Acad Med Singapore., 37(10):831-4.

INTRODUCTION: Imipenem and meropenem are treatment of choice for extended-spectrum betalactamase (ESBL)-positive gram-negative bacteraemia. They may select for carbapenemresistant Acinetobacter baumannii and Pseudomonas aeruginosa; ertapenem may not do so as it is inactive against these bacteria. Clinical efficacy of ertapenem in ESBL-producing gramnegative 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.

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