Lye David Chien, Wijaya Limin, Chan Joey, Teng Chew Ping, Leo Yee Sin
Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.
Ann Acad Med Singap. 2008 Oct;37(10):831-4.
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.
亚胺培南和美罗培南是治疗产超广谱β-内酰胺酶（ESBL）革兰阴性菌血症的首选药物。它们可能会筛选出产碳青霉烯酶的鲍曼不动杆菌和铜绿假单胞菌；厄他培南则不会，因为它对这些细菌无活性。厄他培南在产ESBL革兰阴性菌血症中的临床疗效有限。
对接受厄他培南治疗的产ESBL革兰阴性菌血症患者进行回顾性研究。
47例多重耐药革兰阴性菌血症患者（79%产ESBL）接受了厄他培南治疗，中位疗程为11天。中位年龄为70岁。19%发生感染性休克，17%需要机械通气。肺炎克雷伯菌占53%，大肠埃希菌占26%。尿路感染占61%，肝胆感染占15%。良好临床反应发生率为96%。归因死亡率为4%。
厄他培南在产ESBL革兰阴性菌血症的培养指导下的降阶梯治疗中前景良好。
