Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea.
Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, South Korea.
Antimicrob Agents Chemother. 2022 Jul 19;66(7):e0028722. doi: 10.1128/aac.00287-22. Epub 2022 Jun 16.
Ertapenem is one of the carbapenems recommended for treating extended-spectrum β-lactamase (ESBL)-producing . However, efficacy data are limited. We compared 30-day mortality rates for patients receiving ertapenem and other carbapenems for treatment of ESBL-producing bacteremia. A multicenter, retrospective study was performed from January 2013 to December 2020 at three hospitals. Patients who received only members of one group of carbapenems (group 1 or group 2) throughout their treatment for ESBL-producing Escherichia coli or Klebsiella pneumoniae bacteremia were enrolled. To compare 30-day all-cause mortality rates in the two groups, propensity score matching was used to control for selection bias. Subgroup analyses were performed for several subgroups. Secondary outcomes included Clostridioides difficile infection (CDI) and the emergence of multidrug-resistant Gram-negative bacteria within 90 days after initiation of carbapenem treatment. One-to-one propensity score matching yielded 162 pairs of patients from the total of 603 patients included. There was no difference in 30-day mortality rates between ertapenem and the other carbapenems in adjusted analyses (hazard ratio, 0.60 [95% confidence interval [CI], 0.29 to 1.22]) of the propensity score-matched cohorts. A similar result was obtained in a subgroup analysis of patients who suffered severe sepsis or septic shock and those who did not ( = 0.54 for interaction). Emergence of CDI (odds ratio [OR], 0.99 [95% CI, 0.44 to 2.20]) and carbapenem-resistant (OR, 1.31 [95% CI, 0.51 to 3.53]) did not differ between the two groups. Our study suggests that the efficacy of ertapenem may be comparable to that of the other carbapenems in treatment of ESBL-producing E. coli and K. pneumoniae bacteremia.
厄他培南是治疗产超广谱β-内酰胺酶（ESBL）的推荐碳青霉烯类药物之一。然而，疗效数据有限。我们比较了接受厄他培南和其他碳青霉烯类药物治疗产 ESBL 大肠埃希菌或肺炎克雷伯菌菌血症的患者的 30 天死亡率。一项多中心、回顾性研究于 2013 年 1 月至 2020 年 12 月在三家医院进行。纳入仅接受一种碳青霉烯类药物（1 组或 2 组）治疗产 ESBL 大肠埃希菌或肺炎克雷伯菌菌血症的患者。为了比较两组患者的 30 天全因死亡率，采用倾向评分匹配来控制选择偏倚。对几个亚组进行了亚组分析。次要结局包括艰难梭菌感染（CDI）和碳青霉烯类药物治疗开始后 90 天内出现的多重耐药革兰阴性菌。对总共 603 例患者中的 162 对患者进行了 1:1 的倾向评分匹配。在调整后的分析中，厄他培南与其他碳青霉烯类药物在 30 天死亡率方面无差异（风险比，0.60 [95%置信区间 [CI]，0.29 至 1.22]）。在严重脓毒症或感染性休克患者和非严重脓毒症或感染性休克患者的亚组分析中也得到了类似的结果（=0.54，交互作用）。CDI 的发生率（比值比 [OR]，0.99 [95% CI，0.44 至 2.20]）和耐碳青霉烯类药物的发生率（OR，1.31 [95% CI，0.51 至 3.53]）在两组之间无差异。本研究表明，厄他培南治疗产 ESBL 大肠埃希菌和肺炎克雷伯菌菌血症的疗效可能与其他碳青霉烯类药物相当。
