Vol. 36 No. 1 (2019): February
Antimicrobial

Clinical impact of ertapenem de-escalation in critically-ill patients with Enterobacteriaceae infections

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  • Diana Cuesta,
  • Victor Blanco,
  • Marta Vallejo,
  • Cristhian Hernández-Gomez,
  • Juan J. Maya,
  • Gabriel Motoa,
  • Adriana Correa,
  • Lorena Matta,
  • Fernando Rosso,
  • Ruben D. Camargo,
  • Martin Muñoz,
  • Elizabeth Florez,
  • Jorge Nagles,
  • Amparo Ovalle,
  • Sergio Reyes Salcedo,
  • Maria V. Villegas
Diana Cuesta
Universidad Pontificia Bolivariana
Victor Blanco
Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM; Universidad ICESI; Fundación Clínica Valle del Lili
Marta Vallejo
Universidad Pontificia Bolivariana
Cristhian Hernández-Gomez
Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM
Juan J. Maya
Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM
Gabriel Motoa
Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM
Adriana Correa
Universidad Santiago de Cali
Lorena Matta
Clínica Universitaria Rafael Uribe Uribe
Fernando Rosso
Fundación Clínica Valle del Lili
Ruben D. Camargo
Clínica General Del Norte
Martin Muñoz
Centro Médico Imbanaco
Elizabeth Florez
Hospital General de Medellín
Jorge Nagles
Clínica Las Américas
Amparo Ovalle
Hospital Federico Lleras Acosta
Sergio Reyes Salcedo
Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM
Maria V. Villegas
Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM; Universidad El Bosque

Published 2019-04-05

Keywords

How to Cite

1.
Cuesta D, Blanco V, Vallejo M, Hernández-Gomez C, Maya JJ, Motoa G, Correa A, Matta L, Rosso F, Camargo RD, Muñoz M, Florez E, Nagles J, Ovalle A, Reyes Salcedo S, Villegas MV. Clinical impact of ertapenem de-escalation in critically-ill patients with Enterobacteriaceae infections. Rev. Chilena. Infectol. [Internet]. 2019 Apr. 5 [cited 2026 Jan. 16];36(1). Available from: https://mail.revinf.cl/index.php/revinf/article/view/108

Copyright (c) 2019 Diana Cuesta, Victor Blanco, Marta Vallejo, Cristhian Hernández-Gomez, Juan J. Maya, Gabriel Motoa, Adriana Correa, Lorena Matta, Fernando Rosso, Ruben D. Camargo, Martin Muñoz, Elizabeth Florez, Jorge Nagles, Amparo Ovalle, Sergio Reyes Salcedo, Maria V. Villegas

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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.

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