Conference Coverage

Ertapenem slashes surgical site infections in carriers of ESBL-producing bacteria



– A targeted antibiotic strategy that employed ertapenem in carriers of extended-spectrum beta-lactamase–producing Enterobacteriaceae reduced infections after colorectal surgery by 41%, compared with routine treatment with cefuroxime and metronidazole.

The strategy was even more effective at preventing surgical site infections caused by ESBL-producing bacteria, cutting the rate by 87%, Amir Nutman, MD, said at the European Congress of Clinical Microbiology and Infectious Diseases.

Dr. Amir Nutman of Tel Aviv Michele G. Sullivan/MDedge News

Dr. Amir Nutman

“Screening for ESBL-producing bacteria carriage before colorectal surgery, and adapting prophylaxis for carriers, was highly effective in reducing our surgical site infections,” said Dr. Nutman of Tel-Aviv Sourasky Hospital. “This approach also limits the use of ertapenem prophylaxis to the minimum necessary to achieve a marked reduction in these infections.”

He presented the results of the WP4 study, which was carried out in three hospitals in Serbia, Switzerland, and Israel. Designed as a before-and-after trial, it tested the theory that identifying ESBL carriers and targeting presurgical antibiotic prophylaxis could improve their surgical outcomes.

WP4 was one of five studies in the multinational R-GNOSIS project. “Resistance in gram-negative organisms: Studying intervention strategies” is a 12 million euro, 5-year European collaborative research project designed to identify effective interventions for reducing the carriage, infection, and spread of multidrug resistant Gram-negative bacteria. Several of the studies reported at ECCMID 2018.

During 2012-2017, WP4 enrolled almost 4,000 adults scheduled to undergo colorectal surgery (excluding appendectomy or minor anorectal procedures). All patients were screened for ESBL-producing bacteria from 2 weeks to 2 days before their operation. In the first phase, carriers were treated with the standard presurgical prophylaxis of 1.5 g cefuroxime and 500 mg metronidazole intravenously. In phase 2, carriers received targeted prophylaxis with IV ertapenem 1 g. Both interventions were given 30 minutes before surgery commenced.

All patients underwent regular surgical site infection surveillance until hospital discharge, then followed up 30 days later by phone or in person.


Next Article: