Risk factors for excessively prolonged meropenem use in the intensive care setting: a case-contol study

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Pharmacology

Background:

• Inappropriate use of broad-spectrum antimicrobials poses risks to individual patients and public health.
• Prolonged carbapenem therapy in intensive care units (ICUs) is a concern for antimicrobial stewardship.
• Identifying at-risk patient populations is crucial for targeted antimicrobial stewardship interventions.

Purpose of the Study:

• To identify patients at risk for excessively prolonged carbapenem treatment in the ICU.
• To inform antimicrobial stewardship interventions by pinpointing high-risk patient groups.

Main Methods:

• A case-control study was conducted across 11 university hospital ICUs.
• Patients receiving uninterrupted meropenem therapy (MT) for >4 weeks (cases) were compared to those receiving MT for ≤2 weeks (controls), with both groups staying >4 weeks in the ICU.
• A multivariate logistic regression model identified risk factors associated with prolonged MT.

Main Results:

• 36 patients received uninterrupted MT >4 weeks between 2013-2015.
• Prolonged MT was significantly associated with surgical patients (72.2% vs. 31.5%) and peritonitis (44.4%).
• Multivariate analysis revealed colonization with multidrug-resistant (MDR) Gram-negative bacteria (OR 7.52) and peritonitis (OR 16.96) as significant risk factors for prolonged MT.

Conclusions:

• Surgical patients with peritonitis are at high risk for excessively prolonged carbapenem therapy.
• Patients with known colonization of MDR Gram-negative bacteria require careful monitoring for prolonged carbapenem use.
• These identified patient groups are critical targets for antimicrobial stewardship programs.