Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Clinical efficacy and safety of the FDA approved doses of ertapenem in patients utilizing renal replacement therapies (RRT) are not established
Research Question or Hypothesis: We sought to investigate the efficacy and safety of ertapenem suggested doses in patients with sepsis secondary to ESBL producing Enterobacterales and utilizing RRT.
Study Design: A retrospective observational study conducted at our quaternary care hospital.
Methods: The study was conducted between May 2015 and December 2021. The primary end point was the 30-day mortality, while the secondary end points were the clinical cure, microbiologic cure, 30-day recurrence, and incidence of seizures.
Results: During the study period, 158 met the inclusion criteria. Of those, males were 86 (54.4%), while the mean age was 66.4±13.8 years, and mean weight was 77±22.4 kg. Bacteremia was the most common diagnosis occurred in 48 (30.4%) subjects, followed by urinary tract infection in 39 (22.2%) subjects, then by pneumonia in 35 (22.2%) patients. The most isolated pathogens were Escherichia coli followed by Klebsiella species The median ertapenem dose was 0.5 g intravenous (IV) daily in those who received intermittent hemodialysis (IHD) and 1g IV daily for those who received Continuous Veno-Venous Hemofiltration (CVVH). The 30-day mortality rate was 24%, clinical cure rate was 89.2%, microbiologic cure rate was 82%, 30-day recurrence rate was 41.1%, and the incidence of seizures was 2.5%. The multivariate logistic regression analysis indicated that the age OR 1.04; 95%CI (1.003-1.075), critically ill patients at therapy initiation OR 2.9; 95%CI (1.1-7.5), and Enterobacterales other than Escherichia coli and Klebsiella species OR 3.8; 95%CI (1.1-12.5) were the significant independent risk factors associated with mortality in this population.
Conclusion: Our findings suggest that the suggested doses of ertapenem in patients utilizing IHD and CVVH are clinically effective, however, they may pose higher risk of seizures. A larger pharmacokinetic/outcomes study is needed to validate our findings
Presenting Author
Wasim Elnekidy PharmD, BCPS, BCACPCleveland Clinic Abu Dhabi
Authors
Emna Abidi PhD
Cleveland Clinic Abu Dhabi
Diana Malaeb PharmD, PhD
Gulf Medical University
Amir Malik MD
Cleveland Clinic Abu Dhabi
Jihad Mallat MD
Cleveland Clinic Abu Dhabi
Iyad Ghazal BSc Pharm
College of Pharmacy, Gulf Medical university, Ajman, United Arab Emirates
Islam Ghazi PharmD
Arnold and Marie Schwartz College of Pharmacy
Fadi Hijazi MD
Cleveland Clinic Abu Dhabi
Mohamad Mooty MD
Cleveland Clinic Abu Dhabi
Rania El Lababidi PharmD, BCPS (AQ-ID), AAHIVP
Cleveland Clinic Abu Dhabi