Efficacy of ertapenem in the treatment of early ventilator-associated pneumonia caused by extended-spectrum β-lactamase-producing organisms in an intensive care unit

• Published in: Journal of antimicrobial chemotherapy 2007-08, Vol.60 (2), p.433-435
• Main Authors: Bassetti, Matteo, Righi, Elda, Fasce, Roberta, Molinari, Maria Pia, Rosso, Raffaella, Di Biagio, Antonio, Mussap, Michele, Pallavicini, Franco Bobbio, Viscoli, Claudio
• Format: Article
• Language: English
• Subjects: Aged; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; APACHE; Bacteria - drug effects; beta-Lactamases - metabolism; beta-Lactams - adverse effects; beta-Lactams - therapeutic use; Biological and medical sciences; carbapenems; Enterobacter cloacae; Female; General aspects; hospital; Human infectious diseases. Experimental studies and models; Humans; Infectious diseases; Intensive Care Units; Klebsiella pneumoniae; Liver - drug effects; Liver - enzymology; Male; Medical sciences; Microbial Sensitivity Tests; Pharmacology. Drug treatments; Pilot Projects; Pneumonia, Ventilator-Associated - drug therapy; Pneumonia, Ventilator-Associated - microbiology; Prospective Studies; Proteus mirabilis
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkm180

Objectives Ventilator-associated pneumonia (VAP) is a frequent complication of patients admitted to intensive care units (ICUs). Ertapenem is a newer carbapenem with good in vitro activity against extended-spectrum β-lactamase (ESBL)-producing organisms. However, there are no clinical data to support the use of ertapenem in VAP. Our purpose is to evaluate the usefulness and safety of ertapenem in the treatment of VAP caused by susceptible ESBL strains. Methods Ertapenem 1 g daily intravenously was given to adult patients with signs and symptoms of VAP beginning within 7 days of mechanical ventilation and caused by ESBL-producing Gram-negative organisms. Results From June 2005 to June 2006, we enrolled 20 adult patients hospitalized in an ICU and diagnosed with VAP due to Gram-negative ESBL strains. Causative organisms identified as ESBL producers susceptible to ertapenem were Klebsiella pneumoniae (alone in 10 cases and with methicillin-resistant Staphylococcus aureus in 4 cases), Enterobacter cloacae (2), Proteus mirabilis (2) and Citrobacter freundii (2). Clinical success was achieved in 16/20 (80%) of the clinically evaluable patients and in 15/20 (75%) of the microbiologically evaluable patients. The drug was well-tolerated; one patient presented a transient increase in liver enzymes. Conclusions We believe this is one of the first reports to demonstrate that ertapenem has clinical utility in treating serious infections caused by ESBL-producing organisms. Ertapenem appears to be suitable for ESBL VAP therapy. This pilot study suggests subsequent controlled randomized trials in this indication.