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C/MIC > 4: A Potential Instrument to Predict the Efficacy of Meropenem
Yichang Zhao1,2, Chenlin Xiao1,2, Jingjing Hou1,2
1Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha 410011, China.
Abstract:
This prospective study aimed to explore the determinants of meropenem trough concentration (Ctrough) in patients with bacterial pneumonia and to investigate the association between its concentration and efficacy. From January 2019 to December 2019, patients with pulmonary infections were prospectively enrolled from the intensive care unit. Factors affecting the meropenem trough concentration were analyzed, and a multiple linear regression model was constructed. Logistic regression analyses were used to investigate the relationship between Ctrough and clinical efficacy. A total of 64 patients were enrolled, in whom 210 meropenem concentrations were measured. Of the total, 60.9% (39/64) were considered clinically successful after treatment. Ctrough may increase with increased blood urea nitrogen, albumin, and concomitant antifungal use. By contrast, concentration may decrease with increased endogenous creatinine clearance rate. Six variables, including Ctrough/minimum inhibitory concentration (MIC) > 4, were associated with the efficacy of meropenem. There was an independent correlation between Ctrough/MIC > 4 and efficacy after fully adjusting for confounding factors. Based upon renal function indexes, it is possible to predict changes in meropenem concentration and adjust the dosage precisely and individually. Ctrough/MIC > 4 is a potential instrument to predict successful treatment with meropenem.
Insights
This study found that meropenem trough concentration (Ctrough) in pneumonia patients is influenced by factors like kidney function. Achieving a Ctrough/minimum inhibitory concentration (MIC) ratio greater than 4 is a key predictor of successful treatment.
Area of Science:
- Pharmacokinetics and Pharmacodynamics
- Infectious Diseases
- Critical Care Medicine
Background:
- Meropenem is a critical antibiotic for treating severe bacterial infections, including pneumonia.
- Understanding factors influencing meropenem trough concentration (Ctrough) is vital for optimizing therapeutic efficacy.
- The relationship between Ctrough and clinical outcomes in pneumonia patients requires further investigation.
Purpose of the Study:
- To identify determinants of meropenem Ctrough in patients with bacterial pneumonia.
- To evaluate the association between meropenem Ctrough and treatment efficacy.
- To explore the utility of Ctrough/minimum inhibitory concentration (MIC) ratio as a predictor of treatment success.
Main Methods:
- Prospective enrollment of 64 patients with pulmonary infections in an intensive care unit from January 2019 to December 2019.
- Analysis of factors affecting meropenem Ctrough using multiple linear regression.
- Logistic regression to assess the relationship between Ctrough and clinical efficacy, including the Ctrough/MIC ratio.
Main Results:
- Meropenem Ctrough was positively associated with blood urea nitrogen, albumin, and antifungal use, and negatively with creatinine clearance.
- Clinical success was observed in 60.9% of patients.
- A Ctrough/MIC ratio greater than 4 was independently correlated with meropenem efficacy.
Conclusions:
- Renal function indexes can predict changes in meropenem concentration, enabling precise, individualized dosage adjustments.
- The Ctrough/MIC ratio > 4 serves as a potential predictor for successful meropenem treatment in bacterial pneumonia.
- Optimizing meropenem dosing based on individual patient factors and pharmacokinetic targets can improve treatment outcomes.
