Meropenem by continuous versus intermittent infusion in ventilator-associated pneumonia due to gram-negative bacilli.
BACKGROUND
It is known that beta-lactam antibiotics exhibit time-dependent bactericidal activity. Several studies have found continuous infusion of meropenem more effective than intermittent infusion in maintaining constant serum concentrations in excess of the minimum inhibitory concentration. However, limited data exist on the clinical efficacy of meropenem administered by continuous infusion.


OBJECTIVE
To evaluate the clinical efficacy of continuous versus intermittent infusion of meropenem for the treatment of ventilator-associated pneumonia (VAP) due to gram-negative bacilli.


METHODS
A retrospective cohort study was conducted of patients with VAP caused by gram-negative bacilli who received initial empiric antibiotic therapy with meropenem. We analyzed 2 contemporary cohorts: one group received meropenem by continuous infusion (1 g over 360 min every 6 h), the other by intermittent infusion (1 g over 30 min every 6 h). The administration method was prescribed according to the physician's discretion. Patients received meropenem plus tobramycin for 14 days.


RESULTS
There were no significant differences between patient groups with regard to gender, age, APACHE-II at intensive care unit admission, diagnosis, microorganism responsible for VAP, or organ dysfunction severity at the time VAP was suspected. The group receiving medication by continuous infusion showed a greater clinical cure rate than the group treated with intermittent infusion (38 of 42, 90.47%, vs 28 of 47, 59.57%, respectively, with OR 6.44 [95% CI 1.97 to 21.05; p < 0.001]).


CONCLUSIONS
Meropenem administered by continuous infusion may have more clinical efficacy than intermittent infusion.
Lorente
Leonardo
L
Intensive Care Unit, Hospital Universitario de Canarias, Tenerife, Spain. lorentemartin@msn.com
Lorenzo
Lisset
L
Martín
María M
MM
Jiménez
Alejandro
A
Mora
María L
ML
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000628:therapy*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013845:Thienamycins / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem