Clinical response to ertapenem in severe community-acquired pneumonia: a retrospective series in an elderly population

Authors: Murcia, J. M.¹; González-Comeche, J.²; Marín, A.³; Barberán, J.⁴; Granizo, J. J.⁵; Aguilar, L.⁶; González-Moreno, J.⁷; González-Pina, B.⁸; López-Dupla, M.⁹; Irurzun, J.¹⁰

Source: Clinical Microbiology & Infection, Volume 15, Number 11, November 2009 , pp. 1046-1050(5)

Publisher: Wiley-Blackwell

Abstract:

Clin Microbiol Infect 2009; 15: 1046-1050 Abstract

To evaluate in routine hospital practice the clinical response to ertapenem in comparison with other parenteral antibiotics in the treatment of community-acquired pneumonia (CAP), clinical records from patients with severe CAP treated with ertapenem from July 2002 to June 2006 in seven Spanish hospitals were retrospectively reviewed. Patients were classified according to the Pneumonia Severity Index (PSI). Each ertapenem-treated patient was matched with two patients in the same hospital treated with other antibiotics, according to age (difference ≤5 years), same PSI class and whether or not resident in a nursing home. Seventy-one patients treated with ertapenem and 131 matched controls were identified; 71 of the 202 patients came from nursing homes. A larger (p 0.0002) number of patients were treated with monotherapy in the ertapenem group. In total, 174 patients (86.1%) belonged to PSI classes IV-V; a higher (p <0.0001) PSI score was found in patients from nursing homes. The mean age was 80.5 years (75% of patients >76 years). Comorbidities were present in 193 patients (95.5%). No differences were found in median hospital stay (7 days for ertapenem vs. 10 days for comparators, p 0.066). A slightly higher clinical response rate was obtained for ertapenem vs. comparators (88.7% vs. 77.1%; p 0.0465; OR 2.25; 95% CI 0.99-5.12), with significant differences in clinical response in patients coming from nursing homes (95.8% ertapenem vs. 63.8% comparators; p 0.0034) but not in non-institutionalized patients (85.4% ertapenem vs. 84.5% comparators; p 0.929). The higher clinical response to ertapenem vs. comparators in severe CAP was due to its significantly higher efficacy in healthcare-associated CAP in patients coming from nursing homes.

Keywords: CAP; elderly; ertapenem; hospital practice; nursing homes; retrospective study

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1469-0691.2009.02843.x

Affiliations: 1:  Internal Medicine Department, Hospital General Universitario, Alicante 2:  Internal Medicine Department, Santo y Real Hospital de Caridad, Cartagena, Murcia 3:  Internal Medicine Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza 4:  Infectious Diseases Department, Hospital Central de la Defensa, Madrid 5:  Grana Datos SL, Pozuelo de Alarcón, Madrid 6:  Microbiology Department, School of Medicine, University Complutense, Madrid 7:  Medical Department, Merck Sharp & Dohme de España S.A., Madrid 8:  Internal Medicine Department, Hospital Comarcal del Noroeste, Caravaca de la Cruz, Murcia 9:  Internal Medicine Department, Hospital Joan XXIII, Tarragona 10:  Internal Medicine Department, Hospital de Cruces, Bilbao, Spain

Publication date: 2009-11-01

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• By this author: Murcia, J. M. ;  González-Comeche, J. ;  Marín, A. ;  Barberán, J. ;  Granizo, J. J. ;  Aguilar, L. ;  González-Moreno, J. ;  González-Pina, B. ;  López-Dupla, M. ;  Irurzun, J.

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