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Predictors of Treatment Failure and Mortality among Patients with Septic Shock Treated with Meropenem in the
Mohd Zulfakar Mazlan1,2, Amar Ghassani Ghazali1,2, Mahamarowi Omar1,2
1Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
Background:
The aim of the study was to determine the predictors of meropenem treatment failure and mortality in the Intensive Care Unit (ICU).
Methods:
This was a retrospective study, involving sepsis and septic shock patients who were admitted to the ICU and received intravenous meropenem. Treatment failure is defined as evidence of non-resolved fever, non-reduced total white cell (TWC), non-reduced C-reactive protein (CRP), subsequent culture negative and death in ICU.
Results:
An Acute Physiology and Chronic Health Evaluation II (APACHE II) and duration of antibiotic treatment less than 5 days were associated with treatment failure with adjusted OR = 1.24 (95% CI: 1.15, 1.33; P < 0.001), OR = 65.43 (95% CI: 21.70, 197.23; P < 0.001). A higher risk of mortality was observed with higher APACHE and Sequential Organ Failure Assessment (SOFA) scores, initiating antibiotics > 72 h of sepsis, duration of antibiotic treatment less than 5 days and meropenem with renal adjustment dose with an adjusted OR = 1.21 (95% CI: 1.12, 1.30; P < 0.001), adjusted OR = 1.23 (95% CI: 1.08, 1.41; P < 0.001), adjusted OR = 6.38 (95% CI: 1.67, 24.50; P = 0.007), adjusted OR = 0.03 (95% CI: 0.01, 0.14; P < 0.001), adjusted OR = 0.30 (95% CI: 0.14, 0.64; P = 0.002).
Conclusion:
A total of 50 (14.12%) patients had a treatment failure with meropenem with 120 (48.02%) ICU mortality. The predictors of meropenem failure are higher APACHE score and shorter duration of meropenem treatment. The high APACHE, high SOFA score, initiating antibiotics more than 72 h of sepsis, shorter duration of treatment and meropenem with renal adjustment dose were predictors of mortality.
Insights
Meropenem treatment failure in the ICU is predicted by higher APACHE scores and shorter treatment durations. Mortality risk increases with higher APACHE and SOFA scores, delayed antibiotic initiation, and shorter meropenem courses.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Meropenem is a critical antibiotic for treating severe infections in Intensive Care Units (ICUs).
- Understanding predictors of meropenem treatment failure and mortality is crucial for optimizing patient outcomes.
- Sepsis and septic shock patients receiving meropenem in the ICU are a key focus for this research.
Purpose of the Study:
- To identify key factors predicting meropenem treatment failure in ICU patients.
- To determine the predictors associated with mortality in patients treated with meropenem.
- To inform clinical practice and improve therapeutic strategies for meropenem use.
Main Methods:
- Retrospective study design analyzing data from ICU patients with sepsis or septic shock.
- Intravenous meropenem administration was the primary treatment analyzed.
- Treatment failure was defined by persistent fever, elevated white cell count, elevated C-reactive protein, negative cultures, and death.
Main Results:
- Higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and shorter antibiotic durations (<5 days) predicted treatment failure.
- Increased mortality risk was linked to higher APACHE II and Sequential Organ Failure Assessment (SOFA) scores, delayed antibiotic initiation (>72 hours), and shorter treatment durations.
- Meropenem with renal dose adjustment was associated with both treatment failure and mortality.
Conclusions:
- Higher APACHE II scores and shorter meropenem treatment durations are significant predictors of treatment failure.
- High APACHE II and SOFA scores, delayed antibiotic initiation, and short treatment durations are critical predictors of mortality.
- The study highlights the importance of appropriate dosing and timely administration of meropenem to improve outcomes in critically ill patients.
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