Ai Ming-Ying, Chang Wei-Lun, Liu Chia-Ying
Department of Pharmacy, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Front Microbiol. 2024 Mar 8;15:1337570. doi: 10.3389/fmicb.2024.1337570. eCollection 2024.
Meropenem belongs to the carbapenem class, which is categorized as beta-lactam antibiotics. These antibiotics are administered in intermittent bolus doses at specific time intervals. However, the continuous infusion approach ensures sustained drug exposure, maintaining the drug concentration above the minimum inhibitory concentration (MIC) throughout the entire treatment period. This study aimed to find out the association between continuous infusions of meropenem and mortality rates.
We conducted a search of the PubMed/Medline, EMBASE, Cochrane Central, and ClinicalTrials.gov databases up to 14 August 2023. The six randomized controlled trials (RCTs) were identified and included in our analysis. The random-effects model was implemented using Comprehensive Meta-Analysis software to examine the outcomes.
Our study included a total of 1,529 adult patients from six randomized controlled trials. The primary outcome indicated that continuous infusion of meropenem did not lead to reduction in the mortality rate (odds ratio = 0.844, 95% CI: 0.671-1.061, =0.147). Secondary outcomes revealed no significant differences in ICU length of stay (LOS), ICU mortality, clinical cure, or adverse events between continuous infusion and traditional intermittent bolus strategies of meropenem. Notably, we observed significant improvements in bacterial eradication (odds ratio 19 = 2.207, 95% CI: 1.467-3.320, < 0.001) with continuous infusion of meropenem. Our study also suggested that performing continuous infusion may lead to better bacterial eradication effects in resistant pathogens (coefficient: 2.5175, = 0.0138).
Continuous infusion of meropenem did not result in the reduction of mortality rates but showed potential in improving bacterial eradication. Furthermore, this strategy may be particularly beneficial for achieving better bacterial eradication, especially in cases involving resistant pathogens.
美罗培南属于碳青霉烯类，该类药物被归类为β-内酰胺类抗生素。这些抗生素以特定的时间间隔进行间歇性大剂量给药。然而，持续输注方法可确保持续的药物暴露，在整个治疗期间将药物浓度维持在最低抑菌浓度（MIC）以上。本研究旨在找出美罗培南持续输注与死亡率之间的关联。
我们检索了截至2023年8月14日的PubMed/Medline、EMBASE、Cochrane Central和ClinicalTrials.gov数据库。确定了六项随机对照试验（RCT）并纳入我们的分析。使用综合荟萃分析软件实施随机效应模型来检验结果。
我们的研究共纳入了来自六项随机对照试验的1529名成年患者。主要结果表明，美罗培南持续输注并未导致死亡率降低（优势比=0.844，95%置信区间：0.671-1.061，P=0.147）。次要结果显示，在美罗培南持续输注与传统间歇性大剂量给药策略之间，重症监护病房（ICU）住院时间（LOS）、ICU死亡率、临床治愈率或不良事件方面无显著差异。值得注意的是，我们观察到美罗培南持续输注在细菌清除方面有显著改善（优势比=2.207，95%置信区间：1.467-3.320，P<0.001）。我们的研究还表明，进行持续输注可能对耐药病原体产生更好的细菌清除效果（系数：2.5175，P=0.0138）。
美罗培南持续输注并未降低死亡率，但在改善细菌清除方面显示出潜力。此外，该策略可能对实现更好的细菌清除特别有益，尤其是在涉及耐药病原体的病例中。
