biostudies-literatureGutierrez-Gutierrez BNIAID NIH HHS1672-80https://www.ebi.ac.uk/biostudies/studies/S-EPMC4867097biostudies-literatureUnknown71(6)Data about the efficacy of ertapenem for the treatment of bloodstream infections (BSI) due to ESBL-producing Enterobacteriaceae (ESBL-E) are limited. We compared the clinical efficacy of ertapenem and other carbapenems in monomicrobial BSI due to ESBL-E.A multinational retrospective cohort study (INCREMENT project) was performed (ClinicalTrials.gov identifier: NCT01764490). Patients given monotherapy with ertapenem or other carbapenems were compared. Empirical and targeted therapies were analysed. Propensity scores were used to control for confounding; sensitivity analyses were performed in subgroups. The outcome variables were cure/improvement rate at day 14 and all-cause 30 day mortality.The empirical therapy cohort (ETC) and the targeted therapy cohort (TTC) included 195 and 509 patients, respectively. Cure/improvement rates were 90.6% with ertapenem and 75.5% with other carbapenems (P?=?0.06) in the ETC and 89.8% and 82.6% (P?=?0.02) in the TTC, respectively; 30 day mortality rates were 3.1% and 23.3% (P?=?0.01) in the ETC and 9.3% and 17.1% (P?=?0.01) in the TTC, respectively. Adjusted ORs (95% CI) for cure/improvement with empirical and targeted ertapenem were 1.87 (0.24-20.08; P?=?0.58) and 1.04 (0.44-2.50; P?=?0.92), respectively. For the propensity-matched cohorts it was 1.18 (0.43-3.29; P?=?0.74). Regarding 30 day mortality, the adjusted HR (95% CI) for targeted ertapenem was 0.93 (0.43-2.03; P?=?0.86) and for the propensity-matched cohorts it was 1.05 (0.46-2.44; P?=?0.90). Sensitivity analyses were consistent except for patients with severe sepsis/septic shock, which showed a non-significant trend favouring other carbapenems.Ertapenem appears as effective as other carbapenems for empirical and targeted therapy of BSI due to ESBL-E, but further studies are needed for patients with severe sepsis/septic shock.The Journal of antimicrobial chemotherapyErtapenem for the treatment of bloodstream infections due to ESBL-producing Enterobacteriaceae: a multinational pre-registered cohort study.PMC4867097R01AI072219R01AI063517Pintado VOliver AGonzalez VMachuca ICalbo EFrancisco CNTacconelli EMolina JAlmela MGalvez JRuiz PPrim NFarinas MCHamprecht ACano MEHsueh PRAntoniadou ABou GAzap OKVirmani DRusso AHernandez AGozalo MTuon FFRoilides EAkova MDoi YFalcone MKaraiskos IRodriguez-Bano JPascual AVenditti MTsakris ARiemenschneider FGarcia-Vazquez EBadia CJuan RSBermejo JLowman WAlmirante BMartinez-Martinez LFontanals DPerez-Nadales ESahin AOCarmeli YTorre-Cisneros JPano-Pardo JRPitout Jde Gopegui ERPournaras SGracia-Ahulfinger IGiannella MSchwaber MJSouli MPuig MViale PCisneros JMPerez FNavarro FMirelis BDaikos GGomez-Zorrilla SFernandez-Ruiz Mde Cueto MTumbarello MJove ECanton RREIPI/ESGBIS/INCREMENT GroupPoulakou GMora-Rillo MPena CBonomo RAGasch OSalamanca EGiamarellou HBartoletti MGomez JXercavins MPaterson DLOriguen JGutierrez-Gutierrez BLarrosa NTrecarichi EMIosifidis EHelvaci OMarinescu CIRucci VZarkotou OTubau FLosito ARfalseErtapenem for the treatment of bloodstream infections due to ESBL-producing Enterobacteriaceae: a multinational pre-registered cohort study.Data about the efficacy of ertapenem for the treatment of bloodstream infections (BSI) due to ESBL-producing Enterobacteriaceae (ESBL-E) are limited. We compared the clinical efficacy of ertapenem and other carbapenems in monomicrobial BSI due to ESBL-E.A multinational retrospective cohort study (INCREMENT project) was performed (ClinicalTrials.gov identifier: NCT01764490). Patients given monotherapy with ertapenem or other carbapenems were compared. Empirical and targeted therapies were analysed. Propensity scores were used to control for confounding; sensitivity analyses were performed in subgroups. The outcome variables were cure/improvement rate at day 14 and all-cause 30 day mortality.The empirical therapy cohort (ETC) and the targeted therapy cohort (TTC) included 195 and 509 patients, respectively. Cure/improvement rates were 90.6% with ertapenem and 75.5% with other carbapenems (P?=?0.06) in the ETC and 89.8% and 82.6% (P?=?0.02) in the TTC, respectively; 30 day mortality rates were 3.1% and 23.3% (P?=?0.01) in the ETC and 9.3% and 17.1% (P?=?0.01) in the TTC, respectively. Adjusted ORs (95% CI) for cure/improvement with empirical and targeted ertapenem were 1.87 (0.24-20.08; P?=?0.58) and 1.04 (0.44-2.50; P?=?0.92), respectively. For the propensity-matched cohorts it was 1.18 (0.43-3.29; P?=?0.74). Regarding 30 day mortality, the adjusted HR (95% CI) for targeted ertapenem was 0.93 (0.43-2.03; P?=?0.86) and for the propensity-matched cohorts it was 1.05 (0.46-2.44; P?=?0.90). Sensitivity analyses were consistent except for patients with severe sepsis/septic shock, which showed a non-significant trend favouring other carbapenems.Ertapenem appears as effective as other carbapenems for empirical and targeted therapy of BSI due to ESBL-E, but further studies are needed for patients with severe sepsis/septic shock.2016-01-01T00:00:00Z2016 Jun2021-02-20T06:24:42Z2019-03-27T02:13:39ZS-EPMC48670972690718410.1093/jac/dkv502