Effects of meropenem supply restriction: A multicenter retrospective study

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.