Risk factors for excessively prolonged meropenem use in the intensive care setting: a case-control study

BMC Infectious Diseases

Research Article

Stefan Kluge¹  Dominic Wichmann¹  Juri Katchanov¹  Christina König²  Holger Rohde³  Florian P. Maurer³  Ansgar W. Lohse⁴  Camilla Rothe⁴  Johannes Jochum⁴  Benno Kreuels⁵  Kai Wöstmann⁶  Michael Baehr⁶  Kariem Seoudy⁶ 

[1] Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany;Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany;Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;Division of Infectious Diseases and Tropical Medicine, First Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;Division of Infectious Diseases and Tropical Medicine, First Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;Infectious Disease Epidemiology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany;Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;

关键词: Antimicrobial use;    Antimicrobial stewardship;    Broad-spectrum antibiotics;   

DOI  :  10.1186/s12879-017-2229-8

 received in 2016-10-27, accepted in 2017-01-27,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundInappropriate 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.MethodsCase–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.ResultsBetween 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.ConclusionSurgical 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.

【 授权许可】

CC BY   
© The Author(s). 2017