Evaluation of factors affecting the trough level of meropenem in intensive care patients by therapeutic drug monitoring

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Çakır A., Memiş H., Gün Z. Ü., Bıçakcıoğlu M.

16. World Intensive and Critical Care Congress, İstanbul, Turkey, 26 - 30 August 2023, pp.112, (Summary Text)

  • Publication Type: Conference Paper / Summary Text
  • Doi Number: 10.1016/j.jcrc.2024.154735
  • City: İstanbul
  • Country: Turkey
  • Page Numbers: pp.112
  • Inonu University Affiliated: Yes

Abstract

Significant physiological alterations in critically ill patients affect the pharmacokinetics of drugs (1). Due to these changes, drug concentrations in the blood may remain below the target level, which may result in treatment failure. Therefore, therapeutic drug monitoring (TDM) of antimicrobial drugs is recommended in critically ill patients (2).

The aim of this study is to reveal the relationship between the factors affecting the trough level of meropenem used in intensive care patients.

Patients older than 18 years of age who were hospitalized in the intensive care unit and received meropenem treatment for at least 48 h were included in the study. On the third day of meropenem treatment, blood was drawn from the patient approximately 30 min before drug administration. Afterwards, the collected blood was centrifuged, and its concentrations were analyzed by the Enzyme-Linked Immuno-Sorbent Assay method. A statistical analysis between the obtained drug trough levels and the factors belonging to the patients was performed using Statistical Package for the Social Sciences v27.0.

The study included 38 patients, 26 of which were male. The mean age of the patients was 66.68 ± 16.27. The most common diagnoses were multiple fractures, unspecified (15.79%), cardiac arrest (13.16%), and subarachnoid hemorrhage (10.53%). The most common comorbidities were essential hypertension, atherosclerotic heart disease and hyperlipidemia. The most common microorganism isolated from the patients was Acinetobacter baumannii, and the susceptibility rate to meropenem was found to be as low as 3.45%. The meropenem trough levels are depicted in Fig. 1. The maximum value among meropenem trough levels was found to be 0.63 mg/L, and it was determined that prolonged infusion was given only to the patient from whom this sample was taken. Creatinine clearance cutoff value was determined as 50 mL/min and there was no statistically significant difference between the groups in terms of mean meropenem trough levels (p = 0.651). There was a significant difference in erythrocyte count and hemoglobin values before and after meropenem treatment. These have decreased relative to the baseline after meropenem treatment (p < 0.05). At the same time, it was determined that there was a very significant difference in C-Reactive Protein (CRP) and Sequential Organ Failure Assessment (SOFA) values. After meropenem treatment, CRP decreased compared to baseline, while SOFA score increased (p < 0.001).

In critically ill patients, prolonged infusions of beta-lactam antibiotics may increase blood trough levels. TDM in this population can help evaluate treatment efficacy.