JAC Advance Access published online on May 31, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm180
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Efficacy of ertapenem in the treatment of early ventilator-associated pneumonia caused by extended-spectrum ß-lactamase-producing organisms in an intensive care unit
1 Infectious Diseases Division, San Martino University Hospital, Genoa, Italy 2 ICU Division, San Martino University Hospital, Genoa, Italy 3 Microbiology Laboratory, San Martino University Hospital, Genoa, Italy
Received 29 January 2007; returned 11 April 2007; revised 24 April 2007; accepted 27 April 2007
* Correspondence address. Clinica Malattie Infettive, Azienda Ospedaliera Universitaria San Martino, Largo R.Benzi 10, 16132 Genova, Italy. Tel: +39-010-5555132; Fax: +39-010-3537680; E-mail: mattba{at}tin.it matteo.bassetti{at}hsanmartino.it
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 ß-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.
Key Words: carbapenems , hospital , Klebsiella pneumoniae , Enterobacter cloacae , Proteus mirabilis
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