Journal Club
In this feature, a panel of IDSA members identifies and critiques important new studies in the current literature that have a significant impact on the practice of infectious diseases medicine.
- Ertapenem Is Adequate for Intra-abdominal Infections with Culture Growth of E. faecalis
Click here for the previous edition of Journal Club. For a review of other recent research in the infectious diseases literature, see “In the Literature,” by Stanley Deresinski, MD, FIDSA, in each issue of Clinical Infectious Diseases.
Ertapenem Is Adequate for Intra-abdominal Infections with Culture Growth of E. faecalis
Reviewed by Manie Beheshti, MD
Intra-abdominal infections (IAIs) are typically polymicrobial. Broad-spectrum antimicrobials, such as ertapenem, are typically advised. While ertapenem has limited activity against Enterococcus faecalis, prior studies have demonstrated equal efficacy when compared to piperacillin-tazobactam (PTZ). However, these studies are limited by their small number of cultures growing E. faecalis, which has left a small gap in the literature: Is ertapenem adequate for IAIs with E. faecalis recovered from cultures?
A study published in Open Forum Infectious Diseases aimed to compare IAI patient outcomes in cases with cultures growing E. faecalis. This multicenter observational study across five hospitals in the Johns Hopkins Health System reviewed cases of IAIs with appropriate source control (via surgical drainage or interventional radiology) with intra-abdominal fluid cultures positive for E. faecalis. The primary outcome was clinical failure within 30 days, defined as unplanned intervention, unplanned courses of antibiotics for the original IAI, or death. Exclusion criteria included lack of source control, concomitant use of ertapenem or PTZ, and isolation of organisms resistant to prescribed antibiotics. Two hundred sixteen patients met eligibility criteria. Of note, no extended spectrum β-lactamases were recovered, and 27% of the patients had cultures with sole growth of E. faecalis. Clinical failure occurred in 20% of the 65 patients who received ertapenem and in 24% of the 151 patients who received PTZ. The 30-day composite outcome did not differ between groups.
Despite the small number of patients in the two groups, this study furthers the previous data regarding efficacy of ertapenem in IAIs. Whereas the tendency in practice could be to address every culture-recovered isolate, such as E. faecalis, in these infections, perhaps we should indeed consider ertapenem adequate.
(Fabre et al. Open Forum Infect Dis. 2019;6(1):ofy339.)