Evaluation of the meropenem dosage and administration schedule in patients with bacteremia initial therapy.
Antimicrobial stewardship
Carbapenem
Mortality rate
PK/PD
Journal
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
ISSN: 1437-7780
Titre abrégé: J Infect Chemother
Pays: Netherlands
ID NLM: 9608375
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
18
01
2023
revised:
04
04
2023
accepted:
10
04
2023
medline:
13
6
2023
pubmed:
23
4
2023
entrez:
22
04
2023
Statut:
ppublish
Résumé
The standard meropenem (MEPM) regimen allowed by insurance in Japan is 0.5 g two or three times a day. Differences in dosages and administration schedules in Japan were evaluated. Patients with bacteremia for whom MEPM was used as the initial treatment at our institution between 2016 and 2021 were included. We retrospectively investigated patients classified into two groups: those treated according to severe infections (high-dose groupand others (low-dose group). After propensity score matching, we compared the probability of achieving free drug blood levels above the minimum inhibitory concentration (MIC) in 24 h (%fT > MIC) and outcomes. The probability of 100% fT > MIC was significantly higher in the high-dose group (96.4% vs 74.5%, odds ratio [OR] = 0.3, 95% confidence interval [CI] = 0.2-0.4, P = < 0.001). Regarding outcomes, the 30-day mortality rate was significantly lower in the high-dose group (1.4% vs. 11.4%, OR = 8.0, 95% CI = 1.5-43.7, P = 0.019). To improve outcomes in patients with bacteremia treated with MEPM, support for appropriate antimicrobial use is necessary for compliance with the dosage and administration schedule according to severe infections in initial treatment.
Sections du résumé
BACKGROUND
BACKGROUND
The standard meropenem (MEPM) regimen allowed by insurance in Japan is 0.5 g two or three times a day. Differences in dosages and administration schedules in Japan were evaluated.
METHODS
METHODS
Patients with bacteremia for whom MEPM was used as the initial treatment at our institution between 2016 and 2021 were included. We retrospectively investigated patients classified into two groups: those treated according to severe infections (high-dose groupand others (low-dose group). After propensity score matching, we compared the probability of achieving free drug blood levels above the minimum inhibitory concentration (MIC) in 24 h (%fT > MIC) and outcomes.
RESULTS
RESULTS
The probability of 100% fT > MIC was significantly higher in the high-dose group (96.4% vs 74.5%, odds ratio [OR] = 0.3, 95% confidence interval [CI] = 0.2-0.4, P = < 0.001). Regarding outcomes, the 30-day mortality rate was significantly lower in the high-dose group (1.4% vs. 11.4%, OR = 8.0, 95% CI = 1.5-43.7, P = 0.019).
CONCLUSIONS
CONCLUSIONS
To improve outcomes in patients with bacteremia treated with MEPM, support for appropriate antimicrobial use is necessary for compliance with the dosage and administration schedule according to severe infections in initial treatment.
Identifiants
pubmed: 37086895
pii: S1341-321X(23)00095-8
doi: 10.1016/j.jiac.2023.04.004
pii:
doi:
Substances chimiques
Meropenem
FV9J3JU8B1
Anti-Bacterial Agents
0
Anti-Infective Agents
0
Thienamycins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
749-753Informations de copyright
Copyright © 2023 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest Yuichi Muraki received a honorarium for giving a lecture at Pfizer Japan, Inc. The other authors have no conflicts of interest to declare.