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Ertapenem for ESBL Bacteraemia — SCE Infectious Diseases MCQ

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ModerateAntimicrobial StewardshipErtapenem for ESBL BacteraemiaSCE Infectious Diseases

A 55-year-old man develops sepsis from a urinary source. Blood cultures grow an ESBL-producing Klebsiella pneumoniae. The organism is resistant to all cephalosporins, Ciprofloxacin, and Co-amoxiclav. It is sensitive to Meropenem, Ertapenem, and Nitrofurantoin. He has bacteraemia with pyelonephritis. What is the definitive treatment?

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Correct answer: E — IV Ertapenem 1 g daily (or Meropenem 1 g TDS)

For ESBL-producing Enterobacterales causing bacteraemia, carbapenems remain the gold standard based on the MERINO trial (which showed Piperacillin/Tazobactam was NOT non-inferior to Meropenem for ESBL bacteraemia). Ertapenem (once-daily, OPAT-friendly) is appropriate for urinary-source ESBL bacteraemia without Pseudomonas concern. Meropenem is preferred for severe sepsis or ICU-level illness. Nitrofurantoin achieves negligible serum concentrations and cannot treat systemic infection. Carbapenem stewardship (using Ertapenem to spare Meropenem for Pseudomonas) is an important principle.

Reference: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book