1458. Outpatient Ertapenem Therapy: Efficacy, Safety and Cost in a high prevalence ESBL-producing Enterobacteriaceae setting
Session: Poster Abstract Session: Antimicrobial Stewardship: Outpatient Parenteral Antibiotic Therapy
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Poster PAAI IDdweek 05.10.15.pdf (1.2 MB)
  • Background: The prevalence of drug-resistant microorganisms is growing worldwide, and in our hospital extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli (E. coli) cause 71% of acute pyelonephritis episodes. Ertapenem is an exceptional antibiotic for its once-daily dosing and its broad spectrum of activity, suitable for outpatient parenteral antimicrobial therapy (OPAT). Experience with OPAT in Mexico is unpublished. We aimed to describe clinical outcomes, safety and cost of outpatient ertapenem therapy (OET) at our hospital. 

    Methods: We conducted a clinical series study of adult patients who received OET during 2014, the first year of OPAT establishment in our center. The main outcomes were cure, 30-day mortality, drug adverse effects and complications. For cost analysis, 20 control patients discharged during 2013 with pyelonephritis were randomly selected to compare the cost of inhospital therapy against the cost of the OET in 20 patients with pyelonephritis. 

    Results: Among 99 patients who received OET during 2014, the most common comorbid condition was diabetes mellitus (39%). Urinary tract infections (UTI) accounted for 56% of episodes. Regarding microbiologic data, 52 urine cultures and 55 blood cultures were obtained, of which 61% and 34% respectively, had growth of ESBL-producing E. coli.

    The mean total duration of OET was 15 days. Ninety-eight patients were cured and one patient died from bacteremia secondary to soft tissue infection. Complications during OET were phlebitis in two patients and one case of diarrhea in which Clostridium difficileinfection was discarded. Three patients were readmitted: one for treatment of phlebitis and two more for symptom control. None of the patients had adverse events leading to discontinuation of ertapenem.

    In patients with pyelonephritis that received OET, the cost of the total treatment (ie, inhospital plus outpatient therapy) decreased an average of $1045 US dollars as compared to the cost of inhospital care for control patients. The total number of bed days saved was 857. 

    Conclusion: OET is effective and safe, with a high cure rate and few complications at HGDMGG. It is also cost-saving when compared to inpatient care.

    Arturo Ortiz Alvarez, RESIDENT, Infectology, HOSPITAL GENERAL DR. MANUEL GEA GONZALEZ, MEXICO CITY, Mexico, Patricia Rodriguez Zulueta, Internal Medicine Physician, Infectology, Hospital Manuel Gea Gonzalez, Mexico City, Mexico, Monica Alejandra Delgado Ramirez, MD, HOSPITSAL GENERAL DR MANUEL GEA GONZALEZ, MEXICO CITY, Mexico, Daniel Aguilar-Zapata, MD, Infectious Diseases, Hospital General Dr. Manuel Gea González, Mexico City, Mexico, Rafael Valdez-Vazquez, MD, Infectious Diseases, Hospital General Dr. Manuel Gea Gonzalez, Mexico City, Mexico and Montserrat Cuevas, MEDICAL STUDENT, HOSPITAL GENERAL DR. MANUEL GEA GONZALEZ, MEXICO CITY, Mexico

    Disclosures:

    A. Ortiz Alvarez, None

    P. Rodriguez Zulueta, None

    M. A. Delgado Ramirez, None

    D. Aguilar-Zapata, None

    R. Valdez-Vazquez, None

    M. Cuevas, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.