Thirty-Day Mortality Rates in Patients with Extended-Spectrum β-Lactamase-Producing Enterobacterales Bacteremia Receiving Ertapenem versus Other Carbapenems

Ertapenem is one of the carbapenems recommended for treating extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales. However, efficacy data are limited. We compared 30-day mortality rates for patients receiving ertapenem and other carbapenems for treatment of ESBL-producing Enterobacterales 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 coil 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 diffide 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 (P = 0.54 for interaction). Emergence of CDI (odds ratio [OR], 0.99 [95% CI, 0.44 to 220]) and carbapenem-resistant Enterobacterales (OR, 131 [95% CI, 051 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. coil and K. pneumoniae bacteremia.

Automated summary

This study compared the 30-day mortality rates of patients receiving Ertapenem and other carbapenems for the treatment of ESBL-producing Enterobacterales bacteremia. The results showed that there was no difference in mortality rates between Ertapenem and other carbapenems, suggesting comparable efficacy. The study also found no difference in secondary outcomes such as Clostridioides diffide infection (CDI) and the emergence of multidrug-resistant Gram-negative bacteria.