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Treatment of nosocomial pneumonia: an experience with meropenem
S S Santos1, F R Machado, C R Kiffer
1Infectious Diseases Department, School of Medicine, University of São Paulo, SP, Brazil.
Abstract:
This study aimed at evaluating the efficacy and safety of meropenem as first choice treatment for nosocomial pneumonia (NP) in intensive care units (ICU) in Hospital das Clínicas (HC) - University of São Paulo; a hospital with high incidence of antimicrobial resistance. Prospective, open, and non-comparative trial with meropenem were done in patients with ventilator-associated or aspiration NP in 2 ICUs at HC - University of São Paulo. Etiologic investigation was done through bronchoalveolar lavage and blood cultures prior to study entry. Twenty-five (25) critically ill patients with NP were enrolled (mean age 40 years). Ventilator-acquired pneumonia was responsible for 76% of cases and aspiration NP for 24%. Specific etiologic agents were identified and considered to be clinically and temporally responsible for NP in 11 (44%) patients. A. baumanii was responsible for 6 cases (55%), P. aeruginosa for 3 (27%), and S. aureus for 2 (18%). At completion of treatment, 19 patients (76%) showed either cure (48%) or improvement (28%) after use of meropenem therapy. Mortality was 12% at the end of therapy (8% after excluding 1 non-evaluable patient). After 4 to 6 weeks of follow-up, 12 (48%) patients had improved or been totally cured, and overall mortality was 24%. Clinical complications were observed in 11 patients (44%), with none of them definitely related to the study drug. Meropenem as monotherapy was effective and well-tolerated in most NP patients in our ICU. The low mortality rate in this study might have been due to first choice use of this drug. Controlled, drug comparative clinical trials are needed to support this preliminary observation.
Insights
Meropenem showed efficacy and safety as a first-choice treatment for nosocomial pneumonia (NP) in intensive care units (ICUs). This study suggests meropenem may reduce mortality in critically ill patients with NP.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Nosocomial pneumonia (NP) presents a significant challenge in intensive care units (ICUs), particularly in settings with high antimicrobial resistance.
- Effective first-line treatment strategies are crucial for improving patient outcomes and managing resistant pathogens.
Purpose of the Study:
- To evaluate the efficacy and safety of meropenem as an initial treatment for nosocomial pneumonia in ICU patients.
- To assess meropenem's impact on clinical outcomes, including cure rates, improvement, and mortality, in a high-resistance environment.
Main Methods:
- A prospective, open-label, non-comparative trial involving 25 critically ill patients with ventilator-associated or aspiration NP.
- Etiologic investigation via bronchoalveolar lavage and blood cultures prior to meropenem administration.
- Assessment of clinical cure, improvement, complications, and mortality at the end of therapy and during follow-up.
Main Results:
- Meropenem therapy resulted in cure or improvement in 76% of patients by the end of treatment.
- Identified pathogens included Acinetobacter baumannii (55%), Pseudomonas aeruginosa (27%), and Staphylococcus aureus (18%).
- Overall mortality was 24% at 4-6 weeks follow-up, with 48% of patients showing sustained improvement or cure.
Conclusions:
- Meropenem monotherapy demonstrated effectiveness and good tolerability in treating nosocomial pneumonia in the studied ICU population.
- The observed low mortality rate suggests potential benefits of early meropenem use, warranting further investigation.
- Controlled, comparative clinical trials are recommended to confirm these preliminary findings and establish meropenem's role in NP management.