Ertapenem for treatment of non-severe bacteremic urinary-tract infections due to ESBL-producing Enterobacterales in kidney transplant recipients: a propensity score and DOOR-based analysis.

There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to ESBL-producing Enterobacterales (ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treatment with ertapenem or meropenem and clinical cure in KT recipients with non-severe bacteremic urinary tract infections (B-UTI) caused by ESBL-E. We performed a registered, retrospective, international (29 centers in 14 countries) cohort study (INCREMENT-SOT, NCT02852902). The association between targeted therapy with ertapenem vs. meropenem and clinical cure at day 14 (principal outcome) was studied by logistic regression. Propensity score-matched and desirability of outcome ranking (DOOR) analyses were also performed. A total of 201 patients were included; only 1 patient (treated with meropenem) in the cohort died. Clinical cure at day 14 was reached in 45/100 (45%) and 51/101 (50.5%) of patients treated with ertapenem and meropenem, respectively (adjusted OR 1.29, 95% CI 0.51-3.22; P=0.76); the propensity score-matched cohort included 55 pairs (adjusted OR for clinical cure at day 14: 1.18, 95%CI 0.43-3.29; P=0.74). In this cohort, the proportion of cases treated with ertapenem with better DOOR than with meropenem was 49.7% (95%CI, 40.4-59.1%) when hospital stay was considered. It ranged from 59-67% in different scenarios of a modified (weights-based) DOOR sensitivity analysis when potential ecological advantage or cost were considered besides outcomes. In conclusion, targeted therapy with ertapenem appears as effective as meropenem to treat non-severe B-UTI due to ESBL-E in KT recipients and may have some advantages.