A Retrospective Analysis of Intravenous Push versus Extended Infusion Meropenem in Critically Ill Patients

Area of Science:

• Pharmacology and Critical Care Medicine
• Antimicrobial Stewardship

Background:

• Meropenem is a critical antibiotic for multi-drug-resistant infections.
• Optimizing meropenem efficacy requires maintaining serum concentrations above the minimum inhibitory concentration (MIC).
• Dosing strategies like extended infusion (EI), continuous infusion, and intermittent infusion are used, with varying literature on superiority.

Purpose of the Study:

• To compare the time to clinical stabilization between intravenous push (IVP) and extended infusion (EI) meropenem administration.
• To evaluate the impact of different meropenem dosing strategies on patient outcomes in the intensive care unit (ICU).

Main Methods:

• Retrospective pilot cohort study involving 100 critically ill patients.
• Patients were divided into two groups: IVP meropenem (n=50) and EI meropenem (n=50).
• Data collected included time to clinical stabilization, hospital length of stay, and ICU length of stay.

Main Results:

• No statistically significant difference in overall clinical stabilization achievement between IVP and EI groups (48% vs. 44%, p=0.17).
• Median time to clinical stability was significantly shorter in the EI group (20.4 hours) compared to the IVP group (66.2 hours, p=0.01).
• EI administration was associated with shorter hospital (13 vs. 17 days, p=0.05) and ICU (6 vs. 9 days, p=0.02) lengths of stay.

Conclusions:

• While overall stabilization rates did not differ significantly, extended infusion meropenem demonstrated a trend towards quicker clinical resolution.
• Extended infusion meropenem administration may be a more effective strategy for achieving clinical stability faster in critically ill patients.
• Further prospective studies are warranted to confirm these findings and optimize meropenem dosing for improved patient outcomes.