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

Matteo Bassetti, Elda Righi, Roberta Fasce, Maria Pia Molinari, Raffaella Rosso, Antonio Di Biagio, Michele Mussap, Franco Bobbio Pallavicini, Claudio Viscoli

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)433-435
Number of pages3
JournalJournal of Antimicrobial Chemotherapy
Volume60
Issue number2
DOIs
Publication statusPublished - Aug 2007

Keywords

  • Carbapenems
  • Enterobacter cloacae
  • Hospital
  • Klebsiella pneumoniae
  • Proteus mirabilis

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology

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