Clinical Outcomes Associated with Ertapenem Use in Operative Intra-Abdominal Infection

Authors:
Marco Henriquez, Adam Boukind, Amin Dehghan, Fabiana Sanchez, Marina Eguchi, Ricardo Fonseca, Lindsay Kranker, Matthew Rosengart, Grant Bochicchio

Body of Abstract:
Background:
The Surgical Infection Society’s 2024 Guidelines on the Management of Intra-Abdominal Infection (IAI) include ertapenem as an option in community-acquired IAI scenarios, yet comparative real-world data remain limited. Evaluating the efficacy of ertapenem as compared to other broad-spectrum antibiotic regimens in operative IAI is important for antibiotic stewardship and clinical decision-making. This objective of this study is to determine whether ertapenem use at the time of operative source control is associated with improved outcomes compared with other broad-spectrum antibiotics.

Methods:
We conducted a retrospective, multicenter cohort study using the TriNetX US Collaborative Network (January 2015–November 2025). We included adult patients with intra-abdominal infection who required operative source control. Patients who were pregnant, immunosuppressed, recent transplant recipients, or undergoing chemotherapy were excluded. Patients were grouped into those receiving ertapenem on the day of surgery compared to those treated with other broad-spectrum antibiotic regimens. Propensity score matching 1 to 1 was performed using age, sex, race and ethnicity, body mass index, hemoglobin A1c, and major comorbidities including diabetes, hypertension, ischemic and other heart disease, kidney disease, chronic obstructive pulmonary disease, nutritional deficiencies, malnutrition, nicotine dependence, alcohol related disorders, and socioeconomic or psychosocial factors. Outcomes were assessed over the first 30 postoperative days.

Results:
After matching, 520 patients per cohort were included. Ertapenem use was associated with lower odds of surgical site infection (3.5% vs 6.5%, OR 0.51, p=0.023) and resistant-organism infections (2.9% vs 5.8%, OR 0.49, p=0.022). Thirty-day mortality was reduced (6.9% vs 10.6%, OR 0.63, p=0.037), and median length of stay was shorter (1 vs 2 days, p=0.028). Rates of sepsis/bacteremia, pneumonia, urinary tract infection, ventilator days, and intubation were similar between groups. Downstream broad-spectrum antibiotic use did not differ significantly (25.8% vs 27.1%, p=0.623).

Conclusions:
Among patients who underwent operative source control for intra-abdominal infection, ertapenem use was associated with fewer infections and lower mortality compared with other broad-spectrum antibiotics, without increasing subsequent broad-spectrum exposure. These findings complement SIS guideline recommendations and support further prospective evaluation of ertapenem as a primary empiric option in operative IAI.