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Effects of meropenem supply restriction: A multicenter retrospective study

Yoshimichi Koutake1, Yoji Nagasaki2, Ryosuke Hirata1

  • 1Department of Pharmacy, Clinical Research Institute, NHO Kyushu Medical Center, 1-8-1 Jigyouhama, Chuo-ku, Fukuoka 810-8563, Japan.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|July 19, 2024
PubMed
Abstract

Insights

Meropenem (MEPM) restriction in Japan led to decreased carbapenem use and increased broad-spectrum antibiotics, worsening patient outcomes. This highlights the critical role of carbapenems in treating severe infections, especially during drug shortages.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Public Health

Background:

  • A generic meropenem (MEPM) product faced supply restrictions in Japan from August 2022 to March 2023.
  • This study investigates the consequences of this meropenem shortage.

Purpose of the Study:

  • To evaluate the impact of meropenem (MEPM) restriction on antimicrobial usage patterns.
  • To assess changes in bacteremia mortality and the prevalence of drug-resistant bacteria following the MEPM supply disruption.

Main Methods:

  • A multicenter retrospective study was conducted across five institutions.
  • Antimicrobial use, bacteremia mortality, and drug-resistant bacteria were compared between a control period (pre-restriction) and the MEPM supply restriction period.

Main Results:

  • Carbapenem days of therapy (DOTs) decreased across all institutions, while fourth-generation cephalosporin and piperacillin/tazobactam DOTs increased.
  • The MEPM supply restriction period was associated with significantly higher 30-day and 90-day mortality rates and shorter survival times.
  • Meropenem supply restriction, advanced age, high Pitt Bacteremia Score, low platelet count, low albumin levels, and MRSA bloodstream infections were independent risk factors for 30-day mortality.
  • No significant difference in carbapenem-resistant Pseudomonas aeruginosa and Enterobacteriaceae detection rates was observed between the periods.

Conclusions:

  • Meropenem (MEPM) restriction reduced carbapenem use, increased reliance on other broad-spectrum agents, and negatively impacted bacteremia prognosis.
  • Carbapenems are essential for treating severe infections and are difficult to substitute during unforeseen supply outages.
Keywords:
Antimicrobial resistant bacteriaAntimicrobial useBacteremiaMeropenemSupply restriction

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