Risk factors for excessively prolonged meropenem use in the intensive care setting: a case-control study. Issue 1 (December 2017)

• Record Type: Journal Article
• Authors: Katchanov, Juri; Kreuels, Benno; Maurer, Florian; Wöstmann, Kai; Jochum, Johannes; König, Christina; Seoudy, Kariem; Rohde, Holger; Lohse, Ansgar; Wichmann, Dominic; Baehr, Michael; Rothe, Camilla; Kluge, Stefan
• Is Part Of: BMC infectious diseases. Volume 17:Issue 1(2017)
• Page Start: 1
• Page End: 7
• Publication Date: 2017-12
• Subjects: Antimicrobial use -- Antimicrobial stewardship -- Broad-spectrum antibiotics; Communicable diseases -- Periodicals; Sexually Transmitted Diseases -- Periodicals; 616.905
• DOI: 10.1186/s12879-017-2229-8
• Languages: English
• ISSNs: 1471-2334

Abstract

Abstract Background Inappropriate use of broad-spectrum antimicrobials affects adversely both the individual patient and the general public. The aim of the study was to identify patients at risk for excessively prolonged carbapenem treatment in the ICU as a target for antimicrobial stewardship interventions. Methods Case–control study in a network of 11 ICUs of a university hospital. Patients with uninterrupted meropenem therapy (MT) > 4 weeks were compared to controls. Controls were defined as patients who stayed on the ICU > 4 weeks and received meropenem for ≤ 2 weeks. Associations between case–control status and potential risk factors were determined in a multivariate logistic regression model. Results Between 1st of January 2013 and 31st of December 2015, we identified 36 patients with uninterrupted MT > 4 weeks. Patients with prolonged MT were more likely to be surgical patients (72.2% of cases vs. 31.5% of controls; p ≤ 0.001) with peritonitis being the most common infection (n = 16, 44.4%). In the multivariate logistic regression model colonization with multidrug-resistant (MDR) Gram-negative bacteria (OR 7.52; 95% CI 1.88–30.14, p = 0.004) and the type of infection (peritonitis vs. pneumonia: OR 16.96, 95% CI 2.95–97.49) were associated with prolonged MT. Conclusion Surgical patients with peritonitis and patients with known colonization with MDR Gram-negative bacteria are at risk for excessively prolonged carbapenem therapy and represent an important target population for antimicrobial stewardship interventions.