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Ertapenem for Treatment of Extended-spectrum Beta-lactamase-producing and Multidrug-resistant Gram-negative Bacteraemia

2008; Academy of Medicine, Singapore; Volume: 37; Issue: 10 Linguagem: Inglês

10.47102/annals-acadmedsg.v37n10p831

0304-4602

David Chien Lye, Limin Wijaya, Joey Chan, Chew Ping Teng, Yee‐Sin Leo,

Antibiotics Pharmacokinetics and Efficacy

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.Retrospective study of patients with ESBL-positive gram-negative bacteraemia treated with ertapenem was undertaken.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%.Ertapenem is promising in culture-guided step-down therapy of ESBL-positive gram-negative bacteraemia.