Carbapenem stewardship with ertapenem and antimicrobial resistance-a scoping review

Abstract Consumption of carbapenem has increased due to extended-spectrum beta-lactamase-producing bacteria spreading. Ertapenem has been suggested as a not carbapenem-resistance inducer. We performed a scoping review of carbapenem-sparing stewardship with ertapenem and its impact on the antibiotic resistance of Gram-negative bacilli. We searched PubMed for studies that used ertapenem as a strategy to reduce resistance to carbapenems and included epidemiologic studies with this strategy to evaluate susceptibility patterns to cephalosporins, quinolones, and carbapenems in Gram-negative-bacilli. The search period included only studies in English, up to February 2018. From 1294 articles, 12 studies were included, mostly from the Americas. Enterobacteriaceae resistance to quinolones and cephalosporins was evaluated in 6 studies and carbapenem resistance in 4 studies. Group 2 carbapenem (imipenem/meropenem/doripenem) resistance on A. baumannii was evaluated in 6 studies. All studies evaluated P. aeruginosa resistance to Group 2 carbapenem. Resistance profiles of Enterobacteriaceae and P. aeruginosa to Group 2 carbapenems were not associated with ertapenem consumption. The resistance rate of A. baumannii to Group 2 carbapenems after ertapenem introduction was not clear due to a lack of studies without bias. In summary, ertapenem as a strategy to spare use of Group 2 carbapenems may be an option to stewardship programs without increasing resistance of Enterobacteriaceae and P. aeruginosa. More studies are needed to evaluate the influence of ertapenem on A. baumannii.

Impacto clínico del desescalamiento a ertapenem en pacientes críticos con infecciones por Enterobacteriaceae / Clinical impact of ertapenem de-escalation in critically-ill patients with Enterobacteriaceae infections

Resumen Introducción: Ertapenem ha demostrado eficacia frente a Enterobacteriaceae productoras de β-lactamasas de espectro extendido, pero carece de actividad contra bacterias no fermentadoras; el desescalamiento a este antimicrobiano cuando no existe la presencia de P. aeruginosa podría reducir la presión selectiva contra esta bacteria y mejorar los resultados clínicos. Objetivo: Evaluar el impacto clínico del desescalamiento de antimicrobianos con cobertura anti-pseudomonas a ertapenem, un agente sin este espectro, en pacientes críticos con infecciones por Enterobacteriaceae. Métodos: Se realizó un estudio de cohorte prospectivo en adultos admitidos a Unidades de Cuidado Intensivo (UCI) con infecciones por Enterobacteriaceae, que habían sido desescalados de una cobertura anti-pseudomonas, a un antimicrobiano sin la misma (ertapenem). Se realizó un modelo de riesgo proporcional de Cox comparando mortalidad por cualquier causa y duración de estancia hospitalaria entre aquellos pacientes que permanecieron con cobertura anti-pseudomonas versus aquellos que fueron desescalados a ertapenem. Resultados: 105 pacientes en el grupo anti-pseudomonas fueron comparados con 148 pacientes del grupo de desescalamiento a ertapenem. El desescalamiento estuvo asociado con una menor mortalidad por cualquier causa comparado con los pacientes que permanecieron con cobertura anti-pseudomonas (hazard ratio ajustado 0,24; IC 95%: 0,12-0,46). La estancia hospitalaria en UCI fue similar en ambos grupos. Discusión: Los pacientes de UCI con infecciones por Enterobacteriaceae desescalados a terapia con ertapenem, tuvieron mejores resultados clínicos comparados con aquellos que permanecieron en terapia anti-pseudomonas, sugiriendo que el desescalamiento es una práctica segura en esta población.

Background: Ertapenem has proven to be effective for extended-spectrum beta-lactamases-producing Enterobacteriaceae but lacks activity against non-fermenters; de-escalation to this antibiotic may reduce the selection of resistance to Pseudomonas aeruginosa and improve clinical outcomes. Aim: To evaluate the clinical impact of de-escalation from broad-spectrum anti-pseudomonal agents to ertapenem, a non-pseudomonal antibiotics for Enterobacteriaceae infections in critically-ill patients. Methods: We conducted a prospective cohort study in adult patients admitted to intensive care units (ICUs) who had Enterobacteriaceae infections and were de-escalated from empiric anti-pseudomonal coverage to non-pseudomonal antibiotics. Cox proportional hazards models were performed comparing all-cause mortality and length of hospital stay between patients who remained on anti-pseudomonal coverage versus those who were de-escalated to ertapenem. Results: 105 patients in the anti-pseudomonal group were compared to 148 patients in the ertapenem de-escalation group. De-escalation was associated with lower all-cause mortality compared to patients who remained on anti-pseudomonal coverage (adjusted Hazard Ratio 0.24; 95% CI: 0.12-0.46). The length of ICU stay was similar between the groups. Discussion: ICU patients with Enterobacteriaceae infections de-escalated to ertapenem therapy had better outcomes compared to patients who remained on broad-spectrum, anti-pseudomonal therapy, suggesting that de-escalation is a safe approach amongst ICU patients.

Resistance among Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal and urinary tract infections in Latin American countries: SMART 2013-2015

ABSTRACT Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) are important etiologic agents of nosocomial infection that are frequently resistant to broad-spectrum antimicrobial agents. Gram-negative ESKAPE pathogens were collected from hospitalized patients in 11 Latin American countries from 2013 to 2015 as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART) global surveillance program. In total, 2113 isolates from intra-abdominal infections (IAI) and 970 isolates from urinary tract infections (UTI) were tested against antimicrobial agents using standardized CLSI broth microdilution methodology. Of the agents tested, amikacin demonstrated the highest rates of susceptibility (%) for K. pneumoniae (92.2, 92.3), Enterobacter spp. (97.5, 92.1), and P. aeruginosa (85.3, 75.2) isolates from both IAI and UTI, respectively. Ertapenem (68.5, 62.6) and imipenem (79.2, 75.9) showed substantially higher rates of susceptibility (%) than other β-lactams, including piperacillin-tazobactam (35.9, 37.4) against ESBL-positive isolates of K. pneumoniae from IAI and UTI, respectively. Rates of susceptibility to all agents tested against A. baumannii were ≤30.9%. Gram-negative ESKAPE pathogens isolated from Latin America demonstrated compromised in vitro susceptibility to commonly prescribed broad-spectrum, parenteral antimicrobial agents. Continued surveillance is warranted. New antimicrobial agents with potent activity against Gram-negative ESKAPE pathogens are urgently needed.

Clinical Efficacy of Ertapenem for Recurrent Cystitis Caused by Multidrug-Resistant Extended-Spectrum beta-Lactamase-Producing Escherichia coli in Female Outpatients

PURPOSE: To evaluate the clinical outcomes of ertapenem administered as an outpatient parenteral antibiotic therapy for intractable cystitis caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. MATERIALS AND METHODS: We retrospectively reviewed a case series of 3 years of therapeutic experience with ertapenem for intractable recurrent cystitis caused by ESBL-producing E. coli. Ertapenem 1 g/d was parenterally administered to the patients on an outpatient basis until the acquisition of symptomatic improvement and negative conversion of urine culture. Demographic and clinical characteristics of patients, antimicrobial resistance, and clinical response data were analyzed from the patients' medical records. RESULTS: During the course of this study, a total of 383 patients were diagnosed with cystitis, and 24 of them showed ESBL-producing E. coli (6.26%). The mean treatment duration of all patients was 8.5 days. The early clinical and microbiological cure rates 0 to 7 days after the end of treatment were 91.7% (22/24) and 90.9% (20/22), respectively. The late clinical and microbiological cure rates 4 to 6 weeks after the end of treatment were 72.2% (13/18) at both time points. CONCLUSIONS: Parenteral ertapenem treatment can be an effective and well-tolerated treatment option for intractable recurrent cystitis by multidrug-resistant ESBL-producing E. coli.

Eficacia y seguridad de ertapenem en infecciones urinarias en pediatría: revisión sistemática / Efficacy and safety of ertapenem for urinary tract infections in children: A systemic review

Introducción: Las infecciones urinarias complicadas son una causa común y potencialmente grave de morbilidad en la edad pediátrica. En los últimos años, se ha observado un incremento en la resistencia de los bacilos gram negativos a los antibióticos tanto en las infecciones urinarias intrahospitalarias como en las provenientes de la comunidad. El ertapenem es un antibiótico carbapenémico de amplio espectro, con una estructura diferente de la del resto de antibióticos ß-lactámicos que permite su administración una o dos veces por día y por vía intramuscular lo que permitiría el manejo ambulatorio de esta patología. Objetivo: evaluar la evidencia disponible sobre la eficacia y seguridad de ertapenem en infecciones urinarias en pediatría. Material y Métodos: revisión sistemática de la literatura. Se priorizó la incorporación de revisiones sistemáticas, ensayos clínicos controlados aleatorizados, y cohortes que compararan el uso de ertapenem con otros antibióticos para el tratamiento de infección urinaria complicada y cuyo punto final fuera la seguridad y/o eficacia del antibiótico. Resultados: Luego de la lectura de los resúmenes quedaron seleccionados 7 artículos de los que se dispuso del texto completo. No se encontraron revisiones sistemáticas sobre el tema. Conclusiones: La seguridad y eficacia del ertapenem fue documentada en pocos trabajos pediátricos. Se requieren más estudios de alta calidad de evidencia para recomendar el uso de ertapenem en el manejo de infecciones urinarias complicadas en pediatría. Sin embargo en casos en que sea la única opción de tratamiento ambulatorio podría considerarse su uso (AU)

Introduction: Complicated urinary infections are a common and potentially severe cause of morbidity in children. Over the past years, increased resistance of gram-negative bacilli to antibiotics has been found in both nosocomial- and communityacquired urinary infections. Ertapenem is a broad-spectrum carbapenem antibiotic with a structure different from other ß-lactam antibiotics and once- or twice-daily intramuscular administration allowing for out-patient management of the pathology. Objective: To evaluate the available evidence on efficacy and safety of ertapenem use in urinary infections in children. Material and methods: A systematic review of the literature was conducted. Systematic reviews, randomized controlled trials, and cohort studies comparing the use of ertapenem with other antibiotics for the treatment of complicated urinary infections with the endpoint of safety and/ or efficacy of the antibiotic were considered. Results: After reading the abstracts, seven studies of which the entire text was available were selected. No systemic reviews were found on the topic. Conclusions: Few studies have been published on the safety and efficacy of ertapenem in children. Further high-quality evidence studies are necessary to recommend the use of ertapenem in the management of complicated urinary infections in children. Nevertheless, in cases in which outpatient treatment is the only option the use of ertapenem may be considered (AU)

The modified Hodge test is a useful tool for ruling out Klebsiella pneumoniae carbapenemase

OBJECTIVE: Enterobacteriaceae bacteria harboring Klebsiella pneumoniae carbapenemase are a serious worldwide threat. The molecular identification of these pathogens is not routine in Brazilian hospitals, and a rapid phenotypic screening test is desirable. This study aims to evaluate the modified Hodge test as a phenotypic screening test for Klebsiella pneumoniae carbapenemase. METHOD: From April 2009 to July 2011, all Enterobacteriaceae bacteria that were not susceptible to ertapenem according to Vitek2 analysis were analyzed with the modified Hodge test. All positive isolates and a random subset of negative isolates were also assayed for the presence of blaKPC. Isolates that were positive in modified Hodge tests were sub-classified as true-positives (E. coli touched the ertapenem disk) or inconclusive (distortion of the inhibition zone of E. coli, but growth did not reach the ertapenem disk). Negative results were defined as samples with no distortion of the inhibition zone around the ertapenem disk. RESULTS: Among the 1521 isolates of Enterobacteriaceae bacteria that were not susceptible to ertapenem, 30% were positive for blaKPC, and 35% were positive according to the modified Hodge test (81% specificity). Under the proposed sub-classification, true positives showed a 98% agreement with the blaKPC results. The negative predictive value of the modified Hodge test for detection was 100%. KPC producers showed high antimicrobial resistance rates, but 90% and 77% of these isolates were susceptible to aminoglycoside and tigecycline, respectively. CONCLUSION: Standardizing the modified Hodge test interpretation may improve the specificity of KPC detection. In this study, negative test results ruled out 100% of the isolates harboring Klebsiella pneumoniae carbapenemase 2. The test may therefore be regarded as a good epidemiological tool.

Detection of KPC carbapenem by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry / 中华微生物学和免疫学杂志

Objective To compare the capability of ertapenem-hydrolyzing in various concentrations in KPC-producing Enterobacteriaceae by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry( MALDI-TOF MS).Methods Nineteen KPC-producing Enterobacteriaceae including ten Proteus mirabilis isolates,three Enterobacter aerogenes isolates,two Serratia marcescens isolates,two Citrobacter freundii isolates,one Klebsiella pneumoniae isolate and one Enterobacter cloacae isolate were isolated from 2nd Affiliated Hospital of Zhejiang University; Seven KPC-producing Morganella morganii were isolated from Hangzhou Traditional Chinese Medicine Hospital; Eleven Escherichia coli transconjugants produced the KPC-2 carbapenemase gene were conjugated from seven M.morganii and four P.mirabilis.MALDI-TOF MS was used to detect the ertapenem-hydrolyzing capability in different KPC-producing Enterobacteriaceae.Results When the concentration of ertapenem was 0.1 g/L,ertapenem can be hydrolyzed by KPC carbapenem within 1.5 h and the sensitivity was 100％,all the three peaks produced by ertapenem disappeared; when the concentration of ertapenem raised to 0.3 g/L,the sensitivity fell to 70.3％ (26/37) within 1.5 h,followed with 89.2％ ( 33/37 ) within 2.5 h and 94.6％ (35/37) within 3.5 h; when the concentration of ertapenem raised to 0.5 g/L,the sensitivity was 48.6％ (18/37) within 1.5 h,83.8％ (31/37) within 2.5 h,94.6％ (35/37 ) within 3.5 h.Two independent samples tests indicated that 0.1 g/L of ertapenem group has significant difference with 0.3 g/L and 0.5 g/L group,while there was no significant difference between 0.3 g/L group and 0.5 g/L group; As for the bacteria groups,there are no significant differences between the bacteria groups except the group of P.mirabilis and E.coli.Conclusion MALDI-TOF MS was easy to operate; it can rapidly detect KPC-producing Enterobacteriaceae with high sensitivity and a low false positive rate.0.1 g/L of ertapenem was recommended to detect KPC carbapenem rather than 0.3 g/L and 0.5 g/L; The detection time is short and can be widely applied clinically.

Ertapenem for the treatment of bacterial liver abscess / 中华普通外科杂志

ObjectiveTo explore the efficacy of an antibiotic ertapenem for the treatment of bacterial liver abscess. MethodThe clinical data of 134 hospitalized bacterial liver abscess patients were retrospectively analyzed to evaluate the clinical and bacteriological efficacy of ertapenem from March 2009-2011in our hospital. ResultFever was present in 122 (91％)cases,abdominal pain was complained in 70 (52.2％ ) cases and rigor in 66 (49.3％ ) cases.In 92(68.7％ ) cases the abscess was located in the right lobe of the liver.Leukocytosis and liver dysfunction were found in 73 cases(54.8％ ) and 84 cases (62.7％ ),respectively.Ultrasonography was the most effective diagnostic means for liver abscess.Fortyone cases(30.6％ )were treated conservatively with ertapenem and 82(61.2％ )were treated with ertapenem associated with percutaneous liver puncture aspiration and 11cases (8.2％ )were treated with ertapenem associated with surgery.The clinical success rate was respectively 89％,87.8％,90.9％.The average duration of medication and length of stay were respectively ( 7.0 ± 2.4 ) d and 14.2 d.Ninety-seven pathogens were isolated from samples and predominant strains were Klebsiella species.Bacterial eradication rate was 92.8％.The sensitivities of isolated bacteria to ertapenem were 94.8％.ConclusionsErtapenem administration is effective therapy for bacterial liver abscess.

Comparison of Ertapenem and Ceftriaxone Therapy for Acute Pyelonephritis and Other Complicated Urinary Tract Infections in Korean Adults: A Randomized, Double-Blind, Multicenter Trial

The efficacy and safety of ertapenem, 1 g once daily, were compared with that of ceftriaxone, 2 g once daily, for the treatment of adults with acute pyelonephritis (APN) and complicated urinary tract infections (cUTIs) in a prospective, multicenter, double-blinded, randomized study. After > or = 3 days of parenteral study therapy, patients could be switched to an oral agent. Of 271 patients who were initially stratified by APN (n = 210) or other cUTIs (n = 61), 66 (48.9%) in the ertapenem group and 71 (52.2%) in the ceftriaxone group were microbiologically evaluable. The mean duration of parenteral and total therapy, respectively, was 5.6 and 13.8 days for ertapenem and 5.8 and 13.8 days for ceftriaxone. The most common pathogen was Escherichia coli. At the primary efficacy endpoint 5-9 days after treatment, 58 (87.9%) patients in the ertapenem group and 63 (88.7%) in the ceftriaxone had a favorable microbiological response. When compared by stratum and severity, the outcomes in the two groups were equivalent. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. The results indicate that ertapenem is highly effective and safe for the treatment of APN and cUTIs.

The effect of tigecycline and ertapenem against clinical isolates of Brucella melitensis detected by E-test on different media.

In this study, in vitro activity of tigecycline (TIG) and ertapenem (ERT) against clinical isolates of Brucella melitensis and the effect of different media on in vitro test results were investigated. The in vitro effects of TIG and ERT to 38 B. melitensis isolates were comparatively investigated in brucella agar and 5% sheep blood agar. MIC value of ERT was 0.032 μg/mL in 23 of 38 and 20 of 38 isolates on blood and brucella agar, respectively. Minimum inhibitory concentration values of TIG were substantially different ranging between 0.064-0.25 μg/mL on blood agar. However, MIC values of TIG were similar on brucella agar with 0.25 μg/mL in 15 of 38 isolates and 0.5 μg/mL in 10 of 38 isolates. In conclusion, although ERT and TIG were effective against B. melitensis isolates in vitro, further studies are needed in order to determine the use of these novel drugs in treatment of brucellosis.

Atividade in vitro do Ertapenem e Meropenem contra cepas de Acinetobacter baumannii isoladas em Fortaleza-Ceará / In vitro activities of ertapenem and meropenem against Acinetobacter baumanniiisolated in Fortaleza-Ceará

As carbapenemas: imipenem, meropenem e ertapenem sao as drogas de escolha no tratamento de cepas multidroga resistente de Acinetobacter baumannii. O Ertapenem e um antimicrobiano parenteral administrado uma vez ao dia com excelente atividadein vitro contra bacterias Gram-positivas e Gram-negativas. Foram avaliadas a atividade in vitro do ertapenem e do meropenem contra 27 cepas de A. baumannii isoladas em Fortaleza-Ceara. A resistencia ao ertapenem e meropenem variou em torno de 59% dascepas estudadas. A disseminacao de cepas resistente a antibioticos e um problema de saude publica. Pode ser visto nesse estudo que o ertapenem nao apresentou vantagem em relacao ao meropenem, apresentando o mesmo nivel de resistencia. Esses resultados saoproblematicos, pois o ertapenem foi lancado recentemente no Brasil e ja sao detectados altos niveis de resistencia.

The carbapenems imipenem, meropenem and ertapenem are among the drugs of choice for the treatment of these multidrug-resistant Acinetobacter baumannii infections. Ertapenem is a once-a-day parenteral ‚-lactam antimicrobial agent with excellentin vitro activity against Gram-positive and Gram-negative. We evaluated its in vitro activity of ertapenem and meropenem against strains 27 A. baumannii isolated from Fortaleza-Ceará. The resistance to ertapenem it and meropenem was around 59%. The spread of antibiotic resistance is a major threat to public health. As it can be seen in our study, ertapenem did not present advantage in relation to meropenem, presenting the same levels of resistance. These results are problematic must to the fact that only ertapenem recently started to be used in Brazil and already occur high levels of resistance.

In vitro Activity of Ertapenem and Other Antibiotics Against Extended-spectrum Beta-lactamase Producing Escherichia coli and Klebsiella pneumoniae / 中华医院感染学杂志

OBJECTIVE To analyze in vitro activity of ertapenem and other antibiotics against clinical bacterial isolates of ESBLs-producing Escherichia coli and Klebsiella pneumoniae.METHODS E.coli and K.pneumoniae were identified by WalkAway40 with 21CN.ESBLs-producing isolates confirmed accordance with the CLSI guidelines.E-test strips were used for determining the minimum inhibitory concentration(MIC) of ertapenem,while disk diffusion test was performed on each isolate using 10 ?g ertapenem disc.RESULTS ESBLs-producing strains were isolated mainly from sputum,urine,secretion and blood,most of them were from nephrology,neurosurgery,Respiratory department and ICU.High resistance rates were shown for both E.coli and K.pneumoniae against cefepime,ciprofloxacin(63.42%),SMZco(61.78%),tobramycin(45.22%)and gentamicin(61.14%).Most K.pneumoniae and E.coli isolates were susceptible to amikacin(78.70%) and piperacillin/tazobactam(81.30%).Tmipenem showed 100.00% of activity the isolates.Ertapenem showed activity against 100.00% ESBLs-producing E.coli,one ESBLs-producing K.pneumoniae isolate showed ertapenem resistance and another one intermediate,the ratio of susceptibility was 99.40%,ertapenem had MIC at which 50.00% and 90.00% of the isolates were inhibited of 0.032 ?g /ml and 1.0 ?g /ml for ESBLs-producing organisms respectively.CONCLUSIONS Ertapenem is less active to ESBLs-producing organisms then imipenem.Ertapenem resistance appears to be the most sensitive indicator for detection of KPCs.

Avaliação do ertapenem frente a bacilos gram negativos produtores de enzima beta lactamase de espectro expandido (ESBL) / Evaluation of the ertapenem front to negative bacilli gram enzyme producers beta lactamase of expanded specter (ESBL)

A resistência bacteriana aos agentes antimicrobianos se tornou uma séria ameaça à saúde pública em todo o mundo, transformando-se em um problema crescente tanto nos ambientes hospitalares quanto na vida diária das comunidades. A busca de novas substâncias capazes de reduzir a atuação e a disseminação dessas bactérias resistentes se tornou um objetivo importante a ser alcançado, notadamente no que diz respeito aos bacilos Gram negativos produtores de enzima β-lactamase de espectro expandido (ESBL), principalmente no caso de Klebsiella e Escherichia coli, que apresentam uma crescente resistência aos agentes β-lactâmicos de amplo espectro. O ertapenem se apresenta hoje como uma das novas alternativas para o tratamento de infecções causadas por estas bactérias. Este trabalho tem como objetivo verificar a eficácia do tratamento antimicrobiano com o Ertapenem, nas infecções causadas por ESBL. Os resultados obtidos apontam para a comprovação de sua eficácia, visto que de 50 amostras testadas, de bacilos Gram negativos, comprovadamente ESBL, 48 se mostraram realmente eficientes, eliminando ou impedindo a proliferação de bactérias. Podemos concluir que o Ertapenem sódico realmente atua de forma eficaz no tratamento das infecções causadas por Bactérias comprovadamente produtoras de ESBL

A Randomized, Controlled, Open, Multi-Center Clinical Trial Comparing Ertapenem versus Ceftriaxone plus Metronidazole for the Treatment of Complicated Intra-abdominal Infections in Adults

BACKGROUND: Ertapenem, a novel beta-lactam agent with a wide range of activity, has a pharmacokinetic profile and antimicrobial spectrum that support its potential use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic pathogens encountered in intraabdominal infections. MATERIALS AND METHODS: The prospective, randomized, controlled, open, and multicenter trial was conducted to compare the clinical efficacy and safety of ertapenem with ceftriaxone plus metronidazole as therapy before or following adequate surgical management of complicated intraabdominal infections. RESULTS: One hundred sixty-three patients were included in the modified intent-to-treat population, of which 134 were clinically evaluable. Patients with a wide range of infections were enrolled; perforated appendicitis or periappendiceal abscess were most common. As for the modified intent-to-treat groups, 71 of 72 (98.6%) patients treated with ertapenem and 73 of 80 (91.3%) treated with ceftriaxone/metronidazole showed favorable clinical response. CONCLUSION: In this study, the efficacy of ertapenem was equivalent to ceftriaxone plus metronidazole in the treatment of complicated intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile compared to ceftriaxone plus metronidazole. The results of this trial suggest that ertapenem could be considered as a useful option that could eliminate the need for combination and/or multi-dosed antibiotic regimens for the empiric treatment of complicated intraabdominal infections.

A Randomized, Controlled, Open, Multi-Center Clinical Trial Comparing Ertapenem versus Ceftriaxone plus Metronidazole for the Treatment of Complicated Intra-abdominal Infections in Adults

BACKGROUND: Ertapenem, a novel beta-lactam agent with a wide range of activity, has a pharmacokinetic profile and antimicrobial spectrum that support its potential use as a once-a-day agent for the treatment of common mixed aerobic and anaerobic pathogens encountered in intraabdominal infections. MATERIALS AND METHODS: The prospective, randomized, controlled, open, and multicenter trial was conducted to compare the clinical efficacy and safety of ertapenem with ceftriaxone plus metronidazole as therapy before or following adequate surgical management of complicated intraabdominal infections. RESULTS: One hundred sixty-three patients were included in the modified intent-to-treat population, of which 134 were clinically evaluable. Patients with a wide range of infections were enrolled; perforated appendicitis or periappendiceal abscess were most common. As for the modified intent-to-treat groups, 71 of 72 (98.6%) patients treated with ertapenem and 73 of 80 (91.3%) treated with ceftriaxone/metronidazole showed favorable clinical response. CONCLUSION: In this study, the efficacy of ertapenem was equivalent to ceftriaxone plus metronidazole in the treatment of complicated intraabdominal infections. Ertapenem was generally well tolerated and had a similar safety and tolerability profile compared to ceftriaxone plus metronidazole. The results of this trial suggest that ertapenem could be considered as a useful option that could eliminate the need for combination and/or multi-dosed antibiotic regimens for the empiric treatment of complicated intraabdominal infections.

The benefit of ertapenem on hospital ecology / 中国实用内科杂志

Resistance to antibiotic therapy is a worldwide problem with severe clinical and economic consequences.Among hospitalized patients,antibiotic resistance has been associated with increases in morbidity and mortality,prolonged hospitalization,and increased hospital costs.An important cause of antibiotic resistance is the selection of resistant bacterial strains as a result of inappropriate and/or excessive antibiotic prescribing in the hospital setting;important strategies to control resistance include monitoring and auditing drug use as well as surveillance and reporting of resistance patterns among hospital flora.Traditional antibiotics,such as cephalosporins and fluoroquinolones,are often linked to the emergence of multidrug-resistant gram-negative bacteria,particularly acinetobacter and pseudomonas spp,and increasingly,enterobacteriaceae.Accordingly,the treatment strategy is to think to choose an antibiotics with adequate infection control and lower resistance selection.Studies of relation between antibiotic consumption and antibiotic resistance show that ertapenem,a group 1 carbapenem,can not reduce the susceptibly of other antibiotics to pseudomonas spp,enterobacteriaceae and the others,and be benefit on hospital ecology. Abstract:Summ ary:Resistance to antib iotic therapy is a worldw ide prob lem w ith severe c lin ical and econom ic consequences.A-mong hosp italized patients,antib iotic resistance has been assoc iated w ith increases in morb id ity and mortality,prolonged hosp italization,and increased hosp ital costs.An important cause of antib iotic resistance is the selection of resistant bacteri-al strains as a resu lt of inappropriate and /or excessive antib iotic prescrib ing in the hosp ital setting;important strategies to control resistance inc lude mon itoring and aud iting drug use as well as surve illance and reporting of resistance patterns a-mong hosp ital flora.Trad itional antib iotics,such as cephalosporins and fluoroqu inolones,are often linked to the em ergence ofmu ltidrug-resistant gram-negative bacteria,particu larly ac inetobacter and pseudomonas spp,and increasingly,enterobac-teriaceae.Accord ingly,the treatm ent strategy is to th ink to choose an antib iotics w ith adequate infection control and lower resistance selection.Stud ies of relation between antib iotic consumption and antib iotic resistance show that ertapenem,a group 1 carbapenem,can not reduce the susceptib ly of other antib iotics to pseudomonas spp,enterobacteriaceae and the others,and be benefit on hosp ital ecology.