Clinical outcomes in patients infected with ertapenem-only-resistant Enterobacterales versus multi-carbapenem-resistant Enterobacterales

Gregory Weston, Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Abhigya Giri, The Biostatistics Center, George Washington University, Rockville, MD, USA.
Lauren Komarow, The Biostatistics Center, George Washington University, Rockville, MD, USA.
Lizhao Ge, The Biostatistics Center, George Washington University, Rockville, MD, USA.
Keri R. Baum, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
Erin Abbenante, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
Jason C. Gallagher, Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA.
Jesse T. Jacob, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Keith S. Kaye, Division of Allergy, Immunology and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Angela C. Kim, Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
W Charles Huskins, Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.
Marcus Zervos, Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA.
Erica Herc, Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA.
Robin Patel, Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
David Van Duin, Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.
Yohei Doi, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Document Type

Journal Article

Publication Date

6-12-2024

Journal

The Journal of antimicrobial chemotherapy

DOI

10.1093/jac/dkae186

Abstract

BACKGROUND: Use of anti-carbapenem-resistant Enterobacterales (anti-CRE) agents such as ceftazidime/avibactam has been associated with improved clinical outcome in cohorts that primarily include patients infected with CRE that are resistant to meropenem (MCRE). OBJECTIVES: To clarify whether patients with CRE resistant to ertapenem but susceptible to meropenem (ertapenem-only-resistant Enterobacterales; EORE) benefit from therapy with anti-CRE agents. METHODS: Patients treated for CRE infection in hospitals in the USA between 2016 and 2019 and enrolled in the CRACKLE-2 study were included. The primary outcome was the desirability of outcome ranking (DOOR) assessed at 30 days after index cultures. RESULTS: The EORE group included 213 patients and the MCRE group included 643. The demographics were similar between the groups except for the patients' race and origin before admission. The MCRE group received anti-CRE agents for definitive therapy significantly more frequently compared with the EORE group (30% versus 5% for ceftazidime/avibactam). We did not observe a significant difference between the groups in the adjusted DOOR probability of a more desirable outcome for a randomly selected patient in the EORE group compared with the MCRE group (52.5%; 95% CI, 48.3%-56.7%). The MCRE group had a similar proportion of patients who died at 30 days (26% versus 21%) and who were discharged to home (29% versus 40%), compared with the EORE group. CONCLUSIONS: Patients with clinical EORE infection rarely received anti-CRE agents, but attained similar outcomes compared with patients with MCRE infection. The findings support current IDSA treatment guidance for meropenem- or imipenem-based therapy for treatment of EORE infections.

Department

Public Health Student Works

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