Plasma and intraprostatic concentrations of ertapenem following preoperative single dose administration: a single-centre prospective experience and clinical implications-the ERTAPRO study.
The incidence of urinary tract infections caused by extended-spectrum β-lactamase (ESBL)-producing pathogens is increasing. These infections are associated with a long hospital stay in patients undergoing urological procedures. We aimed to demonstrate that significant intraprostatic diffusion of ertapenem is achieved after a single preoperative administration. A referred sample of 19 patients requiring surgery for benign prostatic hyperplasia was prospectively included. Patients received a 1 g intravenous (i.v.) dose of ertapenem 1 h (n = 10, group A) or 12 h (n = 9, group B) before blood and prostatic samples were collected. Plasma and intraprostatic concentrations of ertapenem were measured using LC-MS/MS. Intraprostatic concentrations were considered satisfactory when higher than the MIC90 value of urinary-targeted pathogens perioperatively and for 40% of the dosing interval. The Wilcoxon test and a pharmacokinetic predictive model were used. Median plasma concentrations of ertapenem were 144.3 mg/L (95% CI 126.5-157.9) in group A and 30.7 mg/L (95% CI 22.9-36.4) in group B (P < 0.001); median intraprostatic concentrations were 16.6 mg/L (95% CI 13.3-31.4 mg/L) and 4.2 mg/L (95% CI 3.1-4.9 mg/L), respectively (P < 0.001), which were above the MIC90 values of bacteria, including ESBL-producers, during surgery and for 40% of the dosing interval. The plasma-to-prostate concentration ratio was not significantly different between groups (P = 0.97). Single-dose i.v. ertapenem reached satisfactory intraprostatic concentrations, suggesting that it could be a relevant prophylactic strategy for carriers of ESBL-producing bacteria undergoing prostatic procedures, which needs to be confirmed by further prospective trials.
['Dariane|Charles|C|', 'Amin|Alexandre|A|', 'Lortholary|Olivier|O|', 'Lalli|Alexandre|A|', 'Michel|Constance|C|', 'Le Guilchet|Thomas|T|', 'Treluyer|Jean-Marc|JM|', 'Nguyen-Khoa|Thao|T|', 'De Toma|Claudia|C|', 'Urien|Saïk|S|', 'Méjean|Arnaud|A|', 'Bourget|Philippe|P|', 'Timsit|Marc-Olivier|MO|']
D061605:Administration, Intravenous D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000900:Anti-Bacterial Agents D019072:Antibiotic Prophylaxis D002853:Chromatography, Liquid D000077727:Ertapenem D006801:Humans D008297:Male D008826:Microbial Sensitivity Tests D008875:Middle Aged D010949:Plasma D011300:Preoperative Care D011467:Prostate D053719:Tandem Mass Spectrometry D055815:Young Adult D047090:beta-Lactams
Ertapenem Urinary tract infection Prostatic hyperplasia Antibiotic prophylaxis Chromatography