Ertapenem as an Antibiotic Prophylaxis for Colectomies and Laparotomies: A Systematic Review

<b><i>Introduction:</i></b> Given concerns for antibiotic resistance, broader spectrum antibiotic agents such as ertapenem are being used for pre-operative prophylaxis. We hypothesize that pre-operative ertapenem prior to laparotomies and colectomies is superior at decreasing surgical site infections (SSIs) compared with other widely used antibiotic agents. <b><i>Methods:</i></b> Medline, Embase, the Cochrane Library, and Web of Science were queried for studies until February 02, 2025. Studies were excluded if they did not evaluate ertapenem as a pre-operative antibiotic prophylaxis in patients undergoing laparotomy or colectomy, the outcome was not SSIs, or it represented a review of prior publications. Three reviewers independently extracted relevant articles, and two performed risk-of-bias analyses. <b><i>Results:</i></b> Of 6,389 abstracts identified, 9 studies remained after full-text review. Seven of the included studies were observational (78%), and two (22%) were randomized controlled trials (RCTs). The median number of patients enrolled was 499 (inter-quartile range 253, 5192). Study populations included colorectal surgery (n = 8) and trauma patients undergoing laparotomy (n = 1). Ertapenem was compared with single-agent second-generation cephalosporins such as cefotetan, cefuroxime, and cefoxitin and to a single-agent penicillin with or without a combined β-lactamase inhibitor (i.e., ampicillin-sulbactam). In total, five (56%) studies showed that ertapenem was superior in preventing SSIs, decreasing SSI rates by as much as 59% (adjusted odds ratio = 0.41 [0.28-0.61]; p < 0.001). <b><i>Conclusion:</i></b> Approximately half of the studies (56%) demonstrated that ertapenem was superior to other commonly used antibiotic prophylaxis regimens in decreasing SSI after laparotomies and colectomies. However, most studies were observational. Therefore, RCTs, especially in trauma, are needed.