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The Case for Intermittent Carbapenem Dosing in Stable Haemodialysis Patients
Vanda Ho1, Felecia Tay2, Jia En Wu3
1Department of Medicine, National University Hospital, National University Health System, Singapore 119228, Singapore.
Purpose:
Antimicrobial resistant infections are common in patients on haemodialysis, often needing long courses of carbapenems. This results in a longer hospital stay and risk of iatrogenic complications. However, carbapenems can be given intermittently to allow for earlier discharge. We aim to describe the clinical outcomes of intermittent versus daily meropenem in stable, intermittently haemodialysed patients.
Methods:
In total, 103 records were examined retrospectively. Data collected include demographics, clinical interventions and outcomes such as hospital length of stay (LOS), 30-day readmission rates and adverse events.
Findings:
Mean age 61.6 ± 14.2 years, 57.3% male. Most common bacteria cultured were Klebsiella pneumoniae (16.5%). The most common indication was pneumonia (27.2%). Mean duration of therapy on meropenem was 12.4 ± 14.4 days; eight patients needed more than 30 days of meropenem. In total, 55.3% did not have intervention for source control; 86.4% received daily dosing of meropenem; 7.8% patients received intermittent dosing of meropenem only, and 5.8 patients received both types of dosing regimens. LOS of the index admission was shorter for the intermittent arm (15.5 ± 7.6 days versus daily: 30.2 ± 24.5 days), though 30-day readmission was higher (50% versus daily: 38.2%).
Implications:
We recommend further rigorous randomised controlled trials to investigate the clinical utility of intermittent meropenem dosing in patients on stable haemodialysis.
Insights
Intermittent meropenem dosing in haemodialysis patients may shorten hospital stays but could increase 30-day readmissions. Further trials are needed to confirm the clinical utility of this antimicrobial strategy.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Antimicrobial resistance is a significant challenge in haemodialysis patients, often necessitating prolonged carbapenem therapy.
- Extended carbapenem use leads to longer hospital stays and increased risk of complications.
Purpose of the Study:
- To compare clinical outcomes of intermittent versus daily meropenem dosing.
- To evaluate the impact on hospital length of stay and readmission rates in stable haemodialysis patients.
Main Methods:
- Retrospective analysis of 103 patient records.
- Data collected included demographics, interventions, length of stay (LOS), 30-day readmissions, and adverse events.
Main Results:
- The intermittent meropenem group had a shorter mean LOS (15.5 days) compared to the daily group (30.2 days).
- However, the 30-day readmission rate was higher in the intermittent arm (50%) versus the daily arm (38.2%).
Conclusions:
- Intermittent meropenem dosing may reduce hospital length of stay in haemodialysis patients.
- Further randomized controlled trials are recommended to fully assess the clinical utility and safety of intermittent meropenem dosing.
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