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

Identifier:  imarina:575110

Handle: https://hdl.handle.net/20.500.11797/imarina575110

Authors:  Murcia, J M; Gonzalez-Comeche, J; Marin, A; Barberan, J; Granizo, J J; Aguilar, L; Gonzalez-Moreno, J; Gonzalez-Pina, B; Lopez-Dupla, M; Irurzun, J

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 <or=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.