Meta-analysis of the efficacy of ertapenem in preventing SSIs after elective colorectal surgery

Abstract

Abstract Background The efficacy of standard surgical antimicrobial prophylaxis (SAP) regimens in preventing surgical site infections (SSIs) after colorectal surgery is declining, along with rising rates of intestinal colonization with antimicrobial resistant (AMR) Enterobacteriaceae and Bacteroides spp. Ertapenem has been approved by the FDA and EMA for SAP in this context, however it has not been used extensively for this indication out of concern for increasing carbapenem-resistance rates. A limited number of studies have investigated the efficacy of ertapenem in preventing SSIs after colorectal surgery, comparing ertapenem with different agents or combinations of agents. Methods A systematic review was conducted following the PRISMA checklist. PubMed, Embase and Cochrane databases were searched for studies measuring the efficacy of ertapenem in preventing SSIs following elective colorectal procedures. Studies were considered eligible if they reported extractable data on the proportion of SSIs and/or on the proportion of AMR pathogens isolated from SSIs. Data from all ertapenem study arms were extracted. A random effects meta-analysis was performed to estimate the overall proportion of SSI. Results Of 1109 identified studies, 5 met the inclusion criteria and were included in the meta-analysis, totalling 3176 participants. The pooled proportion of SSI was 0.10 (95% CI 0.05-0.18; I2=96%; τ2=0.6323; p ≤ 0.01). Only one study reported data on carbapenem resistance: out of 124 isolates from 30 patients, 1 gram negative carbapenem-resistant isolate was identified. Conclusions The pooled proportion of SSI using ertapenem as SAP found in this study is in line with the proportion of SSI using standard SAP found by a recent meta-analysis (Gandra, 2019). According to this analysis, the benefit of ertapenem does not outweigh the risk of further promoting AMR, although results should be interpreted with caution due to the high heterogeneity among included studies. Key messages According to this study, the efficacy of ertapenem in preventing surgical site infections after elective colorectal surgery is comparable to the efficacy of standard surgical antibiotic prophylaxis. The emergence of carbapenem resistance after surgical prophylaxis with ertapenem should be further investigated through longer term studies before widespread use for this indication.