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

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

    Resultado de la investigación: Contribución a una revistaArtículorevisión exhaustiva

    2 Citas (Scopus)

    Resumen

    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.

    Título traducido de la contribuciónClinical impact of ertapenem de-escalation in critically-ill patients with Enterobacteriaceae infections
    Idioma originalEspañol
    Páginas (desde-hasta)9-15
    Número de páginas7
    PublicaciónRevista Chilena de Infectologia
    Volumen36
    N.º1
    DOI
    EstadoPublicada - feb. 2019

    Nota bibliográfica

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

    Palabras clave

    • De-escalation
    • Enterobacteriaceae Infections
    • Ertapenem
    • Intensive care unit
    • Mortality

    Huella

    Profundice en los temas de investigación de 'Impacto clínico del desescalamiento a ertapenem en pacientes críticos con infecciones por Enterobacteriaceae'. En conjunto forman una huella única.

    Citar esto