Abstract:
The use of extended intermittent infusion (EII) or continuous infusion (CI) of meropenem is recommended in ICU patients, but few data comparing these two options are available. We conducted a retrospective cohort study, between 01/01/2019 and 31/03/2020, in a teaching hospital ICU which aimed to determine the meropenem plasma concentrations achieved with CI and EII. We included septic patients treated with meropenem who had ≥1 meropenem plasma trough (Cmin) or steady-state concentration (Css) measurement, as appropriate. Then, we assessed the factors independently associated with attainment of the target concentration (Cmin or Css ≥10 mg/L) and the toxicity threshold (Cmin or Css ≥50 mg/L) using logistic regression models. Among the 70 patients analysed, the characteristics of those treated with EII (N= 33) and CI (N= 37) were balanced with the exception of eGFR: median 30 mL/min/m2 (interquartile range: 30, 84) versus 79 mL/min/m2 (IQR: 30, 124). Of the patients treated with EII, 21 (64%) achieved the target concentration, whereas 31 (97%) of those treated with CI achieved it (P <0.001). Factors associated with target attainment were: CI (odd ratio= 16.28, 95% confidence interval [2.05-407.5]), daily dose ≥40 mg/kg (OR= 12.23, 95%CI [1.76-197.0], P= 0.03) and eGFR (OR= 0.98, 95%CI [0.97-0.99], P= 0.02). Attainment of toxicity threshold was associated with daily dose >70 mg/kg (OR= 35.5, 95%CI [5.61-410.3], P <0.001). In conclusion, our results suggest the use of meropenem CI, at 40-70 mg/kg/day, particularly in septic ICU patients with normal or augmented renal clearance.
Reference:Tournayre S, Mathieu O, Villiet M, Besnard N, Brunot V, Daubin D, Platon L, Corne P, Klouche K, Larcher R. Factors associated with meropenem pharmacokinetic/pharmacodynamic target attainment in septic critically ill patients treated with extended intermittent infusion or continuous infusion. Int J Antimicrob Agents. 2023 May 25:106868. doi: 10.1016/j.ijantimicag.2023.106868. Epub ahead of print. PMID: 37244425.