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Published on: August 30, 2018
Initial Meropenem Plasma Concentration and Its Correlation with Sepsis Mortality: A Real-World Retrospective Study
Zi Wei Deng1,2, Wei Fu3, Feng Chen1
1Department of Clinical Pharmacy, Hunan University of Medicine General Hospital, Huaihua, Hunan, People's Republic of China.
Purpose:
Meropenem is a first-line antibiotic for sepsis in settings with high prevalence of multidrug-resistant organisms due to its broad-spectrum activity. However, the relationship between meropenem plasma concentration and prognosis of sepsis is unclear. This study aims to investigate whether optimizing meropenem plasma levels improves 28-day outcomes in sepsis patients, while also exploring the potential impact of continuous versus intermittent infusion methods.
Patients And Methods:
This real-world retrospective study included 202 sepsis patients treated with meropenem at Hunan University of Medicine General Hospital from January 2022 to December 2023. Patients received either prolonged intravenous infusion or intermittent intravenous infusion of meropenem, as determined by the attending physician. Prolonged infusion involved a 3-hour duration with an infusion pump, while intermittent infusion lasted 30 minutes to 1 hour. Patients were grouped by the quartiles of meropenem plasma concentration (Q1, Q2, Q3, and Q4) to facilitate analysis of dose-response relationships and control for variability in plasma concentration distributions. Mortality rates at 7, 14, and 28 days, as well as the detection rates of resistant bacteria and ICU length of stay, were compared among groups.
Results:
Prolonged intravenous infusion yielded higher meropenem plasma concentrations compared to intermittent infusion (P=0.024), aligning with expected therapeutic targets for optimal antimicrobial efficacy. However, no significant differences were observed in mortality rates at 7, 14, and 28 days between infusion methods or across plasma concentration quartiles. Multivariable logistic regression confirmed these findings after adjusting for confounding factors. Additionally, no significant differences were found in resistant bacteria detection rates or ICU length of stay across quartiles.
Conclusion:
While prolonged infusion increases plasma meropenem concentration, it does not impact 28-day mortality risk, ICU stay, or resistant bacteria detection in sepsis patients. These findings suggest that prolonged infusion may not offer significant clinical advantages over intermittent infusion and highlight the importance of balancing antibiotic use with stewardship principles (Graphical abstract).
Insights
Optimizing meropenem plasma levels through prolonged infusion did not improve 28-day outcomes in sepsis patients. This study found no significant differences in mortality, resistant bacteria, or ICU stay between prolonged and intermittent meropenem infusions.
Area of Science:
- Pharmacology
- Infectious Diseases
- Critical Care Medicine
Background:
- Meropenem is a critical antibiotic for sepsis, especially with multidrug-resistant organisms.
- The link between meropenem plasma concentrations and sepsis patient outcomes remains unclear.
- Optimizing meropenem administration is crucial for effective sepsis management.
Purpose of the Study:
- To determine if higher meropenem plasma concentrations improve 28-day outcomes in sepsis patients.
- To compare the efficacy of continuous versus intermittent meropenem infusion methods.
- To investigate the impact of meropenem infusion strategies on mortality and resistant bacteria detection.
Main Methods:
- A retrospective study of 202 sepsis patients treated with meropenem.
- Patients received either prolonged (3-hour) or intermittent (0.5-1 hour) intravenous infusions.
- Analysis of 28-day mortality, resistant bacteria rates, and ICU length of stay across meropenem plasma concentration quartiles and infusion methods.
Main Results:
- Prolonged infusion achieved higher meropenem plasma concentrations than intermittent infusion (P=0.024).
- No significant differences were found in 7, 14, or 28-day mortality rates between infusion methods or plasma concentration groups.
- Resistant bacteria detection rates and ICU length of stay also showed no significant differences.
Conclusions:
- Prolonged meropenem infusion increases plasma concentrations but does not improve clinical outcomes in sepsis.
- Intermittent and prolonged meropenem infusions appear comparable in efficacy for sepsis patients.
- Findings support judicious antibiotic use and stewardship principles in sepsis management.
