Journal
INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
Volume 16, Issue 1, Pages E47-E52Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.ijid.2011.09.019
Keywords
ESBL; Escherichia coli; Bacteremia; Ertapenem; Mortality
Categories
Funding
- Center for Disease Control, Department of Health, Taiwan [DOH96-DC-1010, DOH97-DC-1005]
- Merck & Co., Inc., Whitehouse Station, New Jersey, USA
- Merck Co.
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Objective: This study assessed the impact of ertapenem and other carbapenems on mortality in patients with monomicrobial extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-EC) bacteremia. Methods: This non-concurrent prospective study included adult patients with ESBL-EC bacteremia during a 2.5-year period at a 2200-bed teaching hospital. We used a multivariate logistic regression model and Cox's proportional hazards model including propensity score analysis to assess variables associated with 30-day mortality. Results: Of 71 patients who met the study criteria, nine died within 3 days. Among the 62 remaining patients who received definitive antimicrobial therapy, 13 died within 30 days. Male gender, ICU stay, solid tumor, and primary bacteremia were independent predictors of 30-day mortality, whereas definitive antimicrobial therapy using either ertapenem or imipenem/meropenem was protective (p < 0.001 and p = 0.002, respectively). Adjustment by propensity score found that ertapenem appeared to exhibit more favorable outcomes, but the difference fell short of statistical significance (hazard ratio 0.02, p = 0.06). Inappropriate initial therapy was not a significant predictor of mortality. Conclusions: ICU stay, but not initial choice of empirical antimicrobial therapy, was a major predictor of mortality. Using a carbapenem as definitive therapy was a protective factor for 30-day mortality. The choice of ertapenem is reasonable for less severely-ill patients who are at risk of ESBL-EC bacteremia and unlikely to have infection due to Pseudomonas aeruginosa. (C) 2011 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
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