[Clinical experience with meropenem in the treatment of severe infections in critically ill patients].
The use of meropenem, a new antibiotic from the carbapenemic family, was analyzed in the treatment of all types of serious infections in patients in critical condition. The global clinical response was satisfactory in 85.4% of the 178 assessable cases, with no significant differences being found in the form of treatment (monotherapy or combination therapy with aminoglycosides and/or glycopeptides) or in the type of infection treated, although the patients that received three or more antibiotics had more treatment failure. In the case of pneumonia, a better clinical response was observed with the use of monotherapy (38/40, 95% vs. 38/47, 80.8%, p = 0.049). The microbiological response was satisfactory in 72.7% of the 110 assessable cases. Initial pathogens persisted in just 8.2% of the cases, with superinfection in 12.7% and colonization in 6.4%. Differences relating to the form of treatment or the area of infection were not detected. The severity of the patient's condition influenced the choice of the form of meropenem treatment (monotherapy or combined therapy). Such factors as the patient's severity, the presence of hypotension or shock, and the need for mechanical ventilation were indicators for the use of two or more antibiotics. The severity also influenced the use of a larger average daily dose, as well as the length of treatment. Adverse reactions were detected in 6 of the 178 (3.37%) assessable patients, with 4 cases of nephrotoxicity, and 2 of hepatotoxicity. Global mortality was 14%, while infection-related mortality was 8.43%.
Alverez Lerma
F
F
Servicio de Medicina Intensiva, Hospital del Mar, Barcelona.
Gil
C L
CL
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D003627:Data Interpretation, Statistical; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006020:Glycopeptides; D006801:Humans; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D018805:Sepsis / Q000188:drug therapy; D012772:Shock, Septic / Q000188:drug therapy; D013845:Thienamycins / Q000008:administration & dosage / Q000627:therapeutic use*
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D013845:Thienamycins; D000077731:Meropenem