The Journal of antimicrobial chemotherapy · 2025
Impact of hypoalbuminemia on patients receiving ertapenem combination therapy for methicillin-susceptible Staphylococcus aureus bacteraemia.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Shah Sunish, Clarke Lloyd G, Balasubramani G K, Peng Lingyi, Smith Brandon J, Shields Ryan K
Аннотация
BACKGROUND: Ertapenem combination therapy has been associated with a faster time to blood culture sterilization in patients with MSSA bacteraemia. However, guidance documents advise avoiding ertapenem in patients with a serum albumin level of <2.5 g/dL for Gram negative infections given that ertapenem is highly protein bound and patients with hypoalbuminemia may experience suboptimal ertapenem exposures.
PATIENTS AND METHODS: This study was a retrospective, multicenter study of consecutive adult patients with MSSA bacteraemia for >48 h who were treated with cefazolin, oxacillin, or nafcillin in combination with ertapenem. Patients with hypoalbuminemia, defined as a serum albumin level of <2.5 g/dL, were compared to those with normal albumin levels. Patients received ertapenem 1 g every 24 h or 500 mg every 24 h if they had a creatinine clearance below 30 mL/min. The primary outcome was time from ertapenem administration to negative blood cultures.
RESULTS: Among the 109 patients who received ertapenem for MSSA bacteraemia, 100 met the inclusion criteria. Thirty-eight percent were patients who inject drugs and 52% had definitive endocarditis. After propensity score weighting, patients with hypoalbuminemia had a significantly longer time to negative blood cultures compared to patients with normal albumin levels (HR=0.45, 95% CI: 0.27-0.72, P = 0.001).
CONCLUSIONS: Among patients with persistent MSSA bacteraemia who were treated with ertapenem combination therapy, patients with hypoalbuminemia had a significantly longer time to negative blood cultures. Pharmacokinetic studies are warranted to confirm if these findings are due to drug exposures or the underlying condition of patients with hypoalbuminemia.
PATIENTS AND METHODS: This study was a retrospective, multicenter study of consecutive adult patients with MSSA bacteraemia for >48 h who were treated with cefazolin, oxacillin, or nafcillin in combination with ertapenem. Patients with hypoalbuminemia, defined as a serum albumin level of <2.5 g/dL, were compared to those with normal albumin levels. Patients received ertapenem 1 g every 24 h or 500 mg every 24 h if they had a creatinine clearance below 30 mL/min. The primary outcome was time from ertapenem administration to negative blood cultures.
RESULTS: Among the 109 patients who received ertapenem for MSSA bacteraemia, 100 met the inclusion criteria. Thirty-eight percent were patients who inject drugs and 52% had definitive endocarditis. After propensity score weighting, patients with hypoalbuminemia had a significantly longer time to negative blood cultures compared to patients with normal albumin levels (HR=0.45, 95% CI: 0.27-0.72, P = 0.001).
CONCLUSIONS: Among patients with persistent MSSA bacteraemia who were treated with ertapenem combination therapy, patients with hypoalbuminemia had a significantly longer time to negative blood cultures. Pharmacokinetic studies are warranted to confirm if these findings are due to drug exposures or the underlying condition of patients with hypoalbuminemia.