title: Adverse events associated with meropenem versus imipenem/cilastatin therapy in a large retrospective cohort of hospitalized infants.
abstract: BACKGROUND
  Carbapenems are commonly used in hospitalized infants despite a lack of complete safety data and associations with seizures in older children. We compared the incidence of adverse events in hospitalized infants receiving meropenem versus imipenem/cilastatin.
  
  
  METHODS
  We conducted a retrospective cohort study of 5566 infants treated with meropenem or imipenem/cilastatin in neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2010. Multivariable conditional logistic regression was performed to evaluate the association between carbapenem therapy and adverse events, controlling for infant factors and severity of illness.
  
  
  RESULTS
  Adverse events were more common with use of meropenem compared with imipenem/cilastatin (62.8/1000 infant days versus 40.7/1000 infant days, P < 0.001). There was no difference in seizures with meropenem versus imipenem/cilastatin (adjusted odds ratio 0.96; 95% confidence interval: 0.68, 1.32). The incidence of death, as well as the combined outcome of death or seizure, was lower with meropenem use-odds ratio 0.68 (0.50, 0.88) and odds ratio 0.77 (0.62, 0.95), respectively.
  
  
  CONCLUSIONS
  In this cohort of infants, meropenem was associated with more frequent but less severe adverse events when compared with imipenem/cilastatin.
authors.affiliation: Duke Clinical Research Institute and Department of Pediatrics, Duke University, Durham, NC 27715, USA.
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
authors.forename: Amy H
authors.initials: AH
authors.lastname: Herring
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Edmund V
authors.initials: EV
authors.lastname: Capparelli
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Kearns
authors.forename: John
authors.initials: J
authors.lastname: van den Anker
authors.forename: Michael
authors.initials: M
authors.lastname: Cohen-Wolkowiez
authors.forename: Reese H
authors.initials: RH
authors.lastname: Clark
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015377:Cilastatin / Q000008:administration & dosage / Q000009:adverse effects*; D000077728:Cilastatin, Imipenem Drug Combination; D015331:Cohort Studies; D004338:Drug Combinations; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D007223:Infant; D015931:Intensive Care, Neonatal; D000077731:Meropenem; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology / Q000473:pathology; D016019:Survival Analysis; D013845:Thienamycins / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination; D000077731:Meropenem