Clínica Universidad de Navarra, Pharmacy Services; and.
Clínica Universidad de Navarra, Anaesthesia and Intensive Care Department, Pamplona, Spain.
Ther Drug Monit. 2021 Apr 1;43(2):256-263. doi: 10.1097/FTD.0000000000000826.
The proper dosage of antibiotics is a key element in the effective treatment of infection, especially in critically ill patients. This study aimed to evaluate the efficacy of optimized meropenem regimens based on pharmacokinetic/pharmacodynamic criteria in patients admitted to the intensive care unit.
This observational, naturalistic, retrospective, unicentric cohort study was performed between May 2011 and December 2017. The clinical and bacteriologic responses of 77 control intensive care unit patients receiving meropenem were compared with those of 77 propensity score-balanced patients who received meropenem dose adjusted by therapeutic drug monitoring. The primary end point of clinical response was a reduction at the end of treatment of at least 80% of the maximum procalcitonin (PCT) value recorded during the meropenem treatment.
The primary end point was met by 55 patients (71.4%) in the adjusted group compared with 41 (53.3%) patients in the control group (mean difference 18.1%, P = 0.02). Fifty-one patients (66.2%) in the adjusted group required a meropenem dose adjustment, being necessary in 46 of them (90.2%) to decrease the dose. The reduction of PCT was the greatest in the adjusted group compared with the unadjusted group (93% versus 85%, P = 0.004); a greater percentage of patients reached a PCT level < 0.5 ng/mL (63.6% versus 41.6%, P = 0.006), and there was a trend toward an improved bacteriologic response (relative risk = 1.27; 95% confidence interval: 0.92-1.56). There were no differences in early mortality or safety between groups.
Adjustment of meropenem therapy by monitoring is a useful strategy for improving meropenem effectiveness in the treatment of infection in critically ill patients, with no impact on safety.
抗生素的适当剂量是有效治疗感染的关键因素，尤其是在重症患者中。本研究旨在评估基于药代动力学/药效学标准的优化美罗培南方案在重症监护病房患者中的疗效。
这是一项观察性、自然主义、回顾性、单中心队列研究，于 2011 年 5 月至 2017 年 12 月进行。比较了 77 例接受美罗培南治疗的重症监护病房患者的临床和细菌学反应与 77 例经治疗药物监测调整美罗培南剂量的患者的反应。临床反应的主要终点是在美罗培南治疗期间记录的最大降钙素原（PCT）值至少降低 80%。
调整组 55 例（71.4%）患者达到主要终点，对照组 41 例（53.3%）（平均差异 18.1%，P = 0.02）。调整组 51 例（66.2%）患者需要调整美罗培南剂量，其中 46 例（90.2%）需要降低剂量。与未调整组相比，调整组 PCT 降低幅度最大（93%比 85%，P = 0.004）；更多的患者达到 PCT 水平<0.5ng/ml（63.6%比 41.6%，P = 0.006），细菌学反应也有改善趋势（相对风险=1.27；95%置信区间：0.92-1.56）。两组患者的早期死亡率或安全性无差异。
通过监测调整美罗培南治疗是提高重症患者感染治疗美罗培南疗效的有效策略，对安全性无影响。
