Evaluation of meropenem doses prescribed in an adult intensive care unit at a large hospital in Serra Gaúcha
Objective: To evaluate the conformity of dose and/or posology of meropenem prescribed in the setting of kidney impairment, otherwise to evaluate the microbiological profile of the germs isolated in those patients. In addition, to measure the extra costs of non-adjusted prescriptions. Method: This work is a Drug Utilization Review. Were included charts of adult patients, of both sex, that had meropenem prescribed between 01/01/2021 and 06/30/2021, while admitted in the ICU regimen, in a large hospital in Serra Gaúcha. For dose analysis, UpToDate was used as guideline, prescriptions from patients on renal replacement therapy, as well as prescriptions from patients who did not have a creatinine result in the 24 hours prior to the prescription of meropenem, were excluded. Results: A total of 2044 prescriptions were evaluated, of which 667 were excluded because they did not meet the inclusion criteria. Of the 1377 prescriptions included, 1003 were considered adequate (73%) and 374 inadequate (27%). Of the doses considered inadequate, 54 were by underdose (14%) and 320 by overdose (86 %). The extra cost measured was US$1.835,21, equivalent to 993 vials of 500 mg. Microbiologically, there was a higher incidence of Gram-negatives: 81% (383/473). Of these, 54% resistant to meropenem (208/383), 5% (20/383) presumed sensitive, 3% (11/383) intrinsically resistant, and 38% (144/383) sensitive in vitro. Conclusion: The findings support the promotion of the service provided by the clinical pharmacist and stewardship programs, both for the promotion of health in intensive care and for the preservation of the financial health of a philanthropic institution.
Adedeji WA. The treasure called antibiotics. Ann Ibadan Postgrad Med. 2016 Dec;14(2):56–57.
Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics [Internet]. Geneva: World Health Organization - WHO. 2017 - [cited 2022 Sep 28]. Disponível em: https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-whichnew-antibiotics-are-urgently-needed
Watanabe M, Iyobe S, Inoue M, et al. Transferable imipenem resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1991 Jan;35(1):147–151. DOI: 10.1128/AAC.35.1.147
Alobaid AS, Wallis SC, Jarrett P, et al. Effect of obesity on the population pharmacokinetics of meropenem in critically ill patients. Am Soc Microbiol. 2016 Jul 22;60(8):4577–4584. DOI: 10.1128/AAC.00531-16
Tamma PD, Aitken SL, Bonomo RA, et al. Guidance on the treatment of extended spectrum β-lactamase producing enterobacterales (ESBL-E), carbapenem-resistant enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P). Infect Dis Soc Am 2022 Aug 25;75(2):187-212. DOI: 10.1093/cid/ciac268
Mousavi S, Behi M, Taghavi MR, et al. Drug utilization evaluation of imipenem and intravenous ciprofloxacin in a teaching hospital. Iran J Pharm Res. 2013 Feb;12(Suppl):161–167.
Levey AS, Stevens LA. Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) Creatinine Equation: More accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis. 2010 Apr;55(4):622–627. DOI: 10.1053/j.ajkd.2010.02.337
Meropenem: drug information [Internet]. Walthan: UpToDate. 2022 - [cited 2022 Out 10]. Disponível em: https://www.uptodate.com/contents/meropenem-drug-information?sectionName=Kidney%20Impairment%20(Adult)&topicId=9613&search=meropenem&usage_type=panel&anchor=F50990438&source=panel_search_result&selectedTitle=1~115&showDrugLabel=true&kp_tab=drug_general&display_rank=1#F50990438
Exchange rates: indicator [Internet]. Paris: Organisation for Economic Co-operation and Development – OECD. 2022 - [cited 2022 Out 13]. Disponível em: https://data.oecd.org/conversion/exchange-rates.htm
Tabelas de pontos de corte para interpretação de CIMs e diâmetros de halos [Internet]. Rio de Janeiro: Brazilian Committee on Antimicrobial Susceptibility Testing – BrCAST. 2022 Apr 14 – [cited 2022 Out 08]. Disponível em: https://brcast.org.br/wp-content/uploads/2022/09/Tabela-pontos-decorte-clinicos-BrCAST-12-abr-22.pdf
Luyt CE, Bréchot N, Trouillet JL, et al. Antibiotic stewardship in the intensive care unit. Crit Care. 2014 Aug 13;18(480)1-12. DOI: 10.1186/s13054-014-0480-6
Al-Hadithi D, Al-Zakwani I, Balkhair A, et al. Evaluation of the appropriateness of meropenem prescribing at a tertiary care hospital: a retrospective study in Oman. Int J Infect Dis. 2020 Jul;96:180–186. DOI: 10.1016/j.ijid.2020.04.045
Abu-Rub LI, Abdelrahman HA, Johar ARA, et al. Antibiotics prescribing in intensive care settings during the COVID-19 era: a systematic review. Antibiotics. 2021 Aug 2;10(935):1-13. DOI: 10.3390/antibiotics10080935
Lamoth F, Buclin T, Pascual A, et al. High cefepime plasma concentrations and neurological toxicity in febrile neutropenic patients with mild impairment of renal function. Antimicrob Agents Chemother. 2010 Oct;54(10):4360–4367. DOI: 10.1128/AAC.01595-08
Salehifar E, Shiva A, Moshayedi M, et al. Drug use evaluation of meropenem at a tertiary care university hospital: a report from northern Iran. J Res Pharm Pract. 2015 Oct-Dec;4(4):222-225. DOI: 10.4103/2279-042X.167047
Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med. 2020 May;46(5):888–906. DOI: 10.1007/s00134-020-05980-0
Muzlovic I, Perme J, Stubljar D. Orotracheal tube as a risk factor for lower respiratory tract infection: preliminar data from a randomised trial. Wien Klin Wochenschr. 2018 May;130(9–10):328–334. DOI: 10.1007/s00508-017-1304-x
Tumbarello M, Trecarichi EM, De Rosa FG, et al. Infections caused by KPC-producing Klebsiella pneumoniae: diferences in therapy and mortality in a multicentre study. J Antimicrob Chemother. 2015 Jul;70(7):2133–2143. DOI: 10.1093/jac/dkv086
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