Impacto clínico del desescalamiento a ertapenem en pacientes críticos con infecciones por Enterobacteriaceae

Translated title of the contribution: Clinical impact of ertapenem de-escalation in critically-ill patients with Enterobacteriaceae infections

Diana P. Cuesta, Victor M. Blanco, Marta E. Vallejo, Cristhian Hernández-Gómez, Juan J. Maya, Gabriel Motoa, Adriana Correa, Lorena Matta, Fernando Rosso, Ruben D. Camargo, Martin Muñoz, Elizabeth Florez, Jorge Nagles, Amparo Ovalle, Sergio Reyes, María V. Villegas

    Research output: Contribution to journalArticlepeer-review

    2 Scopus citations

    Abstract

    Background: Ertapenem has proven to be effective for extended-spectrum beta-lactamases-producing Enterobacteriaceae but lacks activity against non-fermenters; de-escalation to this antibiotic may reduce the selection of resistance to Pseudomonas aeruginosa and improve clinical outcomes. Aim: To evaluate the clinical impact of de-escalation from broad-spectrum anti-pseudomonal agents to ertapenem, a non-pseudomonal antibiotics for Enterobacteriaceae infections in critically-ill patients. Methods: We conducted a prospective cohort study in adult patients admitted to intensive care units (ICUs) who had Enterobacteriaceae infections and were deescalated from empiric anti-pseudomonal coverage to non-pseudomonal antibiotics. Cox proportional hazards models were performed comparing all-cause mortality and length of hospital stay between patients who remained on anti-pseudomonal coverage versus those who were de-escalated to ertapenem. Results: 105 patients in the anti-pseudomonal group were compared to 148 patients in the ertapenem de-escalation group. De-escalation was associated with lower all-cause mortality compared to patients who remained on anti-pseudomonal coverage (adjusted Hazard Ratio 0.24; 95% CI: 0.12-0.46). The length of ICU stay was similar between the groups. Discussion: ICU patients with Enterobacteriaceae infections de-escalated to ertapenem therapy had better outcomes compared to patients who remained on broad-spectrum, anti-pseudomonal therapy, suggesting that de-escalation is a safe approach amongst ICU patients.

    Translated title of the contributionClinical impact of ertapenem de-escalation in critically-ill patients with Enterobacteriaceae infections
    Original languageSpanish
    Pages (from-to)9-15
    Number of pages7
    JournalRevista Chilena de Infectologia
    Volume36
    Issue number1
    DOIs
    StatePublished - Feb 2019

    Bibliographical note

    Publisher Copyright:
    © 2019, Sociedad Chilena de Infectologia. All rights reserved.

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