Carbapenem use in critically ill patients

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Pharmacology

Background:

• Carbapenems are broad-spectrum antibiotics with excellent activity against resistant Gram-negative bacteria like extended-spectrum β-lactamase (ESBL) producers, AmpC hyperproducers, Pseudomonas aeruginosa, and Acinetobacter baumannii.
• They are often the empirical treatment of choice for suspected sepsis in patients with known or suspected ESBL-producing Enterobacterales (ESBLE) carriage.

Purpose of the Study:

• To review available data on carbapenem utilization in the Intensive Care Unit (ICU).
• To examine the role of carbapenems in treating severe infections and the impact of their use on antimicrobial resistance.

Main Methods:

• Review of existing literature and data on carbapenem use in ICU settings.
• Analysis of carbapenem activity against specific resistant pathogens.
• Evaluation of factors contributing to carbapenem resistance, including consumption patterns and dosing strategies.

Main Results:

• Carbapenems remain the preferred agents for severe ESBLE infections.
• High-dose, off-label carbapenem use is often necessary for critically ill patients with sepsis and hyperfiltration.
• Overuse and lack of systematic re-evaluation of carbapenem therapy contribute to increased resistance in Enterobacteriaceae, A. baumannii, and P. aeruginosa within ICUs.

Conclusions:

• Carbapenems are essential for severe infections, but their broad spectrum necessitates careful stewardship.
• Emerging carbapenem resistance is directly linked to increased consumption.
• Recommendations include high-dose initial therapy, daily reassessment, de-escalation to narrower agents when possible, and early discontinuation to mitigate resistance pressure.