290. Ertapenem Usage for Documented Infections at a Comprehensive Cancer Center
Session: Poster Abstract Session: Antimicrobial Therapy: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • IDSA 2011 Ertapenem.pdf (200.3 kB)
  • Background: Frequent and prolonged usage of broad-spectrum antibiotics like meropenem and 3rd generation cephalosporins have been associated with the emergence of multidrug-resistant organisms (MDROs). Published data regarding the safety and efficacy of ertapenem (ET) for infections in cancer patients (pts) are scarce. The objective of this study was to describe our clinical experience in cancer patients receiving ET for documented infections (DIs).

    Methods: In this retrospective review, we identified 100 pts who received ET for DIs between  Jan 2007 and Feb 2011. Failure to respond was defined as no change in or actual progression of clinical and radiologic parameters or persistently positive microbiologic cultures after at least 72 hrs of ET. Partial response was defined as improvement but not complete resolution of radiologic, clinical and microbiologic end points at the end of ET.

    Results: Mean age was 51 y. (23-79 yrs) with 55% females and 51% whites. Most pts had hematologic malignancies (54%) and/or had progressive cancer (71%). Most common DIs were pneumonia (21%), bacteremia (13%), non-neutropenic fever (12%), and UTI (14%). Most common organisms isolated were E. Coli (21%), Klebsiella sp. (11%), Hemophilus (5%) and Beta hemolytic streptococci (8%). Mean duration of ET in-patient (N=91) and out-patient therapy (N=29) was 5.2 d and 5 d, respectively. The switch to ET from other antibiotics was done in 64 pts with mean time to switch of 7 d (4-10 d). The reasons for switch to ET in these pts were antibiotic failure (60%), to facilitate early discharge (25%) or for de-escalation (15%). ET success was seen in 94% while partial response and failure to respond were documented in 5% and 1% respectively. The failure to ET was seen in a pt with complicated MDR E. Coli bacteremia who relapsed within a month of end of ET therapy.

    Conclusion:Ertapenem for DIs is a good alternative therapy for pts with cancer. It should be used in this instance as a de-escalation option or for outpatient therapy to facilitate discharges.


    Subject Category: A. Antimicrobial agents and Resistance

    Sminil N. Mahajan, MD, Infectious Diseases, Infection Control, Employee Health, MD Anderson Cancer Center, Houston, TX, Roy Chemaly, MD, MPH, Infectious Diseases, Infection Control and Employee Health, University of Texas - MD Anderson Cancer Center, Houston, TX and Kenneth V. I. Rolston, M.D., Dept. of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX

    Disclosures:

    S. N. Mahajan, None

    R. Chemaly, MERCK: Investigator, Research grant

    K. V. I. Rolston, MERCK: Investigator, Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.