title: Meropenem by continuous versus intermittent infusion in ventilator-associated pneumonia due to gram-negative bacilli.
abstract: 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.
authors.affiliation: Intensive Care Unit, Hospital Universitario de Canarias, Tenerife, Spain. lorentemartin@msn.com
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lorente
authors.forename: Lisset
authors.initials: L
authors.lastname: Lorenzo
authors.forename: María M
authors.initials: MM
authors.lastname: Martín
authors.forename: Alejandro
authors.initials: A
authors.lastname: Jiménez
authors.forename: María L
authors.initials: ML
authors.lastname: Mora
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem