Chacón-González Constanza, Rivera-Salgado Daniel, Brenes-Chacón Helena, Naranjo-Zuñiga Gabriela, Ávila-Aguero María L
Pediatrics, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", San José, CRI.
Medicine, Universidad de Ciencias Médicas (UCIMED), San José, CRI.
Cureus. 2021 Jun 21;13(6):e15809. doi: 10.7759/cureus.15809. eCollection 2021 Jun.
Background Understanding antibiotic profiles and their resistance patterns can improve hospital quality care and optimize clinical outcomes. This paper characterizes the use of meropenem in the National Children's Hospital of Caja Costarricense del Seguro Social (CCSS) in Costa Rica, and its role in antibiotic stewardship. Methods This is a retrospective observational study from hospitalized patients under 13 years of age that received meropenem as part of their treatment. Patients were identified through medical and pharmacy records. Data was summarized using frequencies and percentages for categorical variables, means and standard deviations for normally distributed continuous variables, and medians with interquartile ranges (IQR) for non-normally distributed continuous variables. Results A total of 181 of the 309 selected patients met inclusion criteria. Median age was 21 months (IQR: 4.0-79.0). Mean length of stay was 31 days (16.0-58.0). The most frequent diagnosis was septic shock (29%). 87% of patients received at least one antibiotic prior to receiving meropenem; 71% of patients received a second antibiotic simultaneously with meropenem. In 113 (62%) cases, meropenem was prescribed as empirical therapy. The most frequent isolate was extended-spectrum ß-lactamase (24%). 74% of patients who received meropenem as targeted therapy had a favorable outcome. Conclusions Meropenem can be used as monotherapy for complicated, multi-drug resistant, gram negative, bacterial infections, due to its susceptibility profile, convenient dosing schedule, and minimum adverse effects. However, it should be restricted to cases where no other drug is available in order to safeguard its value.
背景 了解抗生素概况及其耐药模式可改善医院医疗质量并优化临床结果。本文描述了美罗培南在哥斯达黎加社会保险银行国家儿童医院（CCSS）的使用情况及其在抗生素管理中的作用。方法 这是一项针对13岁以下住院患者的回顾性观察研究，这些患者接受美罗培南作为治疗的一部分。通过医疗和药房记录识别患者。分类变量的数据使用频率和百分比进行汇总，正态分布的连续变量使用均值和标准差进行汇总，非正态分布的连续变量使用中位数和四分位数间距（IQR）进行汇总。结果 309名选定患者中共有181名符合纳入标准。中位年龄为21个月（IQR：4.0 - 79.0）。平均住院时间为31天（16.0 - 58.0）。最常见的诊断是感染性休克（29%）。87%的患者在接受美罗培南之前至少接受过一种抗生素治疗；71%的患者在接受美罗培南的同时接受了第二种抗生素治疗。在113例（62%）病例中，美罗培南被作为经验性治疗药物开具。最常见的分离菌是超广谱β-内酰胺酶（24%）。接受美罗培南作为靶向治疗的患者中有74%获得了良好的结果。结论 由于美罗培南的敏感性特征、方便的给药方案和最小的不良反应，它可作为复杂性、多重耐药革兰氏阴性菌感染的单一疗法使用。然而，为了维护其价值，应仅限于没有其他药物可用的情况。
