Journal
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
Volume 65, Issue 11, Pages -Publisher
AMER SOC MICROBIOLOGY
DOI: 10.1128/AAC.01102-21
Keywords
ertapenem; extended-spectrum-beta-lactamase-producing Enterobacterales; ESBL-E; urinary tract infection; UTI; bloodstream infection; BSI; kidney transplant
Categories
Funding
- Instituto de Salud Carlos III (ISCIII), Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Ciencia, Innovacion y Universidades, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0001, RD16/0016/0002, RD16/0016/0008, RD16/0016/00010]
- European Development Regional Fund A way to achieve Europe, Operative program Intelligent Growth 2014-2020
- ESCMID Study Group for Infections in Compromised Hosts (ESGICH grant)
- Sociedad Andaluza de Trasplante de Organo Solido (SATOT)
- ESCMID Study Group for Bloodstream Infections and Sepsis (ESGBIS)
- Spanish Ministry of Science and Innovation, ISCIII [PI 18/01849, PI 16/01631, CP 18/00073]
- Plan Nacional de I+D+i 2013-2016
- ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS)
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The efficacy of ertapenem in treating B-UTI caused by ESBL-E in KT recipients remains inconclusive, with similar clinical cure rates to meropenem. Ertapenem may offer some advantages in certain scenarios, as indicated by propensity score matching and DOOR analyses.
There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treatment with ertapenem or meropenem and clinical cure in KT recipients with nonsevere bacteremic urinary tract infections (B-UTI) caused by ESBL-E. We performed a registered, retrospective, international (29 centers in 14 countries) cohort study (INCREMENT-SOT, NCT02852902). The association between targeted therapy with ertapenem versus meropenem and clinical cure at day 14 (the principal outcome) was studied by logistic regression. Propensity score matching and desirability of outcome ranking (DOOR) analyses were also performed. A total of 201 patients were included; only 1 patient (treated with meropenem) in the cohort died. Clinical cure at day 14 was reached in 45/100 (45%) and 51/101 (50.5%) of patients treated with ertapenem and meropenem, respectively (adjusted OR 1.29; 95% CI 0.51 to 3.22; P = 0.76); the propensity score-matched cohort included 55 pairs (adjusted OR for clinical cure at day 14, 1.18; 95% CI 0.43 to 3.29; P = 0.74). In this cohort, the proportion of cases treated with ertapenem with better DOOR than with meropenem was 49.7% (95% CI, 40.4 to 59.1%) when hospital stay was considered. It ranged from 59 to 67% in different scenarios of a modified (weights-based) DOOR sensitivity analysis when potential ecological advantage or cost was considered in addition to outcome. In conclusion, targeted therapy with ertapenem appears as effective as meropenem to treat nonsevere B-UTI due to ESBL-E in KT recipients and may have some advantages.
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