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



Case-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.



Between 1stof January 2013 and 31stof 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.



Surgical 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.
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. j.katchanov@uke.de.
Juri
J
Katchanov
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.
Benno
B
Kreuels
Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Florian P
FP
Maurer
Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Kai
K
Wöstmann
Division of Infectious Diseases and Tropical Medicine, First Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Johannes
J
Jochum
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.|Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Christina
C
König
Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Kariem
K
Seoudy
Department of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Holger
H
Rohde
Division of Infectious Diseases and Tropical Medicine, First Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Ansgar W
AW
Lohse
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Dominic
D
Wichmann
Hospital Pharmacy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Michael
M
Baehr
Division of Infectious Diseases and Tropical Medicine, First Medical Department, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Camilla
C
Rothe
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Stefan
S
Kluge
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D000077731:Meropenem; D008875:Middle Aged; D016017:Odds Ratio; D010538:Peritonitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D012307:Risk Factors; D013845:Thienamycins / Q000008:administration & dosage*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem
Antimicrobial stewardship; Antimicrobial use; Broad-spectrum antibiotics