Informations générales (source: ClinicalTrials.gov)
Effect of Imipenem and Meropenem on the Digestive Microbiota and the Emergence and Carriage of Multidrug-resistant Bacteria (MERIMI)
Observational
Fondation Hôpital Saint-Joseph (Voir sur ClinicalTrials)
janvier 2023
décembre 2025
29 juin 2024
Among enterobacteria, ESBL production is the leading cause of multidrug resistance. The
first cases of ESBL-producing Enterobacteriaceae (EBLSE) infections were described in the
1980s and subsequently spread worldwide.
Since the turn of the century, the prevalence of EBLSE infections, particularly among E.
coli and K. pneumoniae, has increased dramatically. The emergence of multidrug-resistant
enteric bacteria (MRE) is currently a real public health problem. The European network
for monitoring antibiotic resistance in cooperation with Santé Publique France evaluated
the rate of resistance to third generation cephalosporins (C3G) among clinical strains at
10.2% for Escherichia coli and 28.8% for Klebsiella pneumoniae. The consequences of
infections with multi-resistant enteric bacteria, mainly represented by ESBL, are
currently well known, both from an individual point of view (increased mortality and
length of hospitalization) and from a collective point of view (increased costs of care).
The current reference treatment for ESBL-producing Enterobacteriaceae infections is based
on carbapenems.
Imipenem and meropenem are the two most commonly used carbapenems in clinical practice.
Despite their similar spectrum of action, these two molecules have different
pharmacokinetic properties, notably concerning their half-life and their elimination
routes (mainly urinary for imipenem, mixed: biliary and urinary for meropenem).
Some studies have suggested that imipenem has a low impact on the digestive microbiota.
However, no studies comparing the impact of imipenem and meropenem have been conducted.
Woerther et coll. explained in their work that the digestive microbiota confers
resistance to colonization by MREs. The impact of antibiotics on the microbiota probably
leads to a breakdown of this barrier and a loss of this resistance to colonization.
Moreover, each antibiotic therapy does not impact the digestive microbiota in the same
way and it seems that antibiotics with a high activity against strict anaerobic species
and/or a high biliary elimination are the most impacting. It is therefore essential, in
the era of multidrug resistance, to look at the influence of antibiotics on the digestive
microbiota and on the emergence and carriage of MRE.
In a context where the incidence of multi-resistant bacteria is constantly increasing, it
seems relevant to conduct a study aiming at comparing the respective impact of the use of
imipenem and meropenem on the emergence of MRE and on the digestive microbiota at the
individual level. This study aims at comparing the microbiological impact (in terms of
emergence of bacterial resistance and in terms of impact on the diversity of cultivable
digestive bacteria). It will be a comparative study with matching of patients according
to age, service and previous duration of hospitalization. Indeed, the usual management of
patients with an infection requiring treatment with a carbapenem is different between the
2 participating centers. Thus, according to the usual management of patients in these 2
participating centers, patients at Avicenne Hospital are treated with meropenem and
patients at the Paris Saint-Joseph Hospital Group with imipenem, except in the case of a
need for a high daily dose (osteoarticular infection, for example) due to the
neurological toxicity of imipenem at high dosage. In the case of high-dose use, meropenem
will be the preferred molecule.
Etablissements
| Les établissements d'Île-de-France dont les données sont issues de ClinicalTrials.gov Origine et niveau de fiabilité des données | |||||
|---|---|---|---|---|---|
| AP-HP - Hôpital Avicenne | Jean-Ralph Zahar, MD | Contact (sur clinicalTrials) | |||
| GH PARIS SITE SAINT JOSEPH | Benoit PILMIS, MD | Contact (sur clinicalTrials) | |||
Critères
Tous
Inclusion Criteria:
- Patient ≥ 18 years old
- Patient hospitalized in the intensive care unit of the Groupe Hospitalier Paris
Saint-Joseph or the Avicenne Hospital
- Patient with an infection requiring probabilistic or documented treatment with a
carbapenem (imipenem or meropenem)
- French speaking patient
- Patient or relative able to give his or her non-objection
- Patient ≥ 18 years old
- Patient hospitalized in the intensive care unit of the Groupe Hospitalier Paris
Saint-Joseph or the Avicenne Hospital
- Patient with an infection requiring probabilistic or documented treatment with a
carbapenem (imipenem or meropenem)
- French speaking patient
- Patient or relative able to give his or her non-objection
- Patients with a carbapenem allergy
- Pregnant or breastfeeding woman
- Patient under guardianship or curatorship
- Patient deprived of liberty
- Patient under court protection