CLINICAL OUTCOMES AND MORTALITY RATE AMONG CRITICALLY ILL PATIENTS WITH SEPSIS OR SEPTIC SHOCK TREATED WITH MEROPENEM
DOI:
https://doi.org/10.69598/tbps.18.1.71-86Keywords:
meropenem, bacterial infection, mSOFA score, sepsis, septic shockAbstract
Sepsis and septic shock are associated with high mortality. Meropenem is currently used as empirical therapy in patients with sepsis and septic shock. The objectives of this study were 1) to study the causative pathogen of sepsis or septic shock in patients in intensive care units (ICU) 2) to evaluate the clinical outcomes of patients 3) to study factors associated with mortality and 4) to study the relationship between the delta mSOFA score (the changing of mSOFA scores at days after received meropenem and mSOFA score at day 1) and mortality in patients who received meropenem. This retrospective observational study was performed at Phra Phutthabat Hospital from January 2018 to November 2021. Data was collected on a total of 74 patients who met the inclusion criteria. The mSOFA scores were collected on days 1, 2, 4, 7 and 10 of the meropenem treatment. Mortality rates were evaluated on days 14 and 28. The most frequently identified pathogens were Escherichia coli (35.1%), carbapenem-resistant Acinetobacter baumannii (20.3%), and Klebsiella pneumoniae (18.9%). The 14 and 28 day-mortality rates were 25.7% and 39.2%, respectively. From the multivariable analysis, we found that the significant factors affecting the 28-day mortality were the delta mSOFA between day 4 and day 1 ≤-1 (Odd ratio; OR 0.02, 95% CI [0.00,0.20]), septic shock (OR 9.15, 95% CI [1.57,53.26]), and the appropriate use of meropenem according to susceptibility testing results (OR 0.01, 95% CI [0.00,0.10]). In conclusion, this study found that patients who were treated with meropenem for sepsis or septic shock had a high mortality rate. In addition, appropriate use of meropenem, patients’ conditions, and severity of illness were risk factors for the high mortality rate.
References
Cecconi M, Evans L, Levy M, Rhodes A. Sepsis and septic shock. Lancet. 2018;392(10141):75-87.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-10.
Plevin R, Callcut R. Update in sepsis guidelines: what is really new? Trauma Surg Acute Care Open 2017;0:1-6.
Grissom CK, Brown SM, Kuttler KG, Boltax JP, Jones J, Jephson AR, et al. A modified sequential organ failure assessment score for critical care triage. Disaster Med Public Health Prep. 2010;4(4):277-84.
Gholipour Baradari A, Sharifi H, Firouzian A, Daneshiyan M, Aarabi M, Talebiyan Kiakolaye Y, et al. Comparison of proposed modified and original sequential organ failure assessment scores in predicting ICU mortality: a prospective, observational, follow-up study. Scientifica (Cairo). 2016;2016:7379325.
Baharoon S, Telmesani A, Tamim H, Alsafi E, Aljohani S, Mahmoud E, et al. Community- versus nosocomial-acquired severe sepsis and septic shock in patients admitted to a tertiary intensive care in Saudi Arabia, etiology and outcome. J Infect Public Health. 2015;8(5):418-24.
Indrawattana N, Vanaporn M. Nosocomial infection. J Med Health Sci. 2015;22:81-90.
ศูนย์เฝ้าระวังเชื้อดื้อยาต้านจุลชีพแห่งชาติ (NARST) สถาบันวิจัยวิทยาศาสตร์สาธารณสุข กรมวิทยาศาสตร์การแพทย์. สถานการณ์เชื้อดื้อยาต้านจุลชีพปี 2000-2019.Available from: http://narst. dmsc.moph.go.th/data/AMR%202000-2019-12M.pdf
Zhanel GG, Wiebe R, Dilay L, Thomson K, Rubinstein E, Hoban DJ, et al. Comparative review of the carbapenems. Drugs. 2007;67(7):1027-52.
Seok H, Song J, Jeon JH, Choi HK, Choi WS, Moon S, et al. Timing of antibiotics in septic patients: a prospective cohort study. Clin Microbiol Infect. 2020;26(11):1495-500.
Khwannimit B, Bhurayanontachai R. The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting. Epidemiol Infect. 2009;137(9):1333-41.
Zhou J, Qian C, Zhao M, Yu X, Kang Y, Ma X, et al. Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China. PLoS One. 2014;9(9):e107181.
Angkasekwinai N, Rattanaumpawan P, Thamlikitkul V. Epidemiology of sepsis in Siriraj Hospital 2007. J Med Assoc Thai. 2009; 92(Suppl2): S68-78.
Santimaleeworagun W, Wacharasint P, Saelim W, Suphanklang J, Duangmee K, Ruenroengbun N, et al. Clinical outcomes and mortality risk factors among intensive care unit patients with bacteremia at a university hospital. SEHS. 2021:21050008-.
Ahmed N, Jen S-P, Altshuler D, Papadopoulos J, Pham VP, Dubrovskaya Y. Evaluation of meropenem extended versus intermittent infusion dosing protocol in critically ill patients. J Intensive Care Med. 2020;35(8):763-71.
Lertwattanachai T, Montakantikul P, Tangsujaritvijit V, Sanguanwit P, Sueajai J, Auparakkitanon S, et al. Clinical outcomes of empirical high-dose meropenem in critically ill patients with sepsis and septic shock: a randomized controlled trial. J Intensive Care. 2020;8:26.
Napolitano LM. Sepsis 2018: Definitions and Guideline Changes. Surg Infect (Larchmt). 2018;19(2):117-25.
Mira JC, Gentile LF, Mathias BJ, Efron PA, Brakenridge SC, Mohr AM, et al. Sepsis pathophysiology, chronic critical illness, and persistent inflammation-immunosuppression and catabolism syndrome. Crit Care Med. 2017;45(2):253-62.
Sapra A, Malik A, Bhandari P. Vital Sign Assessment: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
Liang C-A, Lin Y-C, Lu P-L, Chen H-C, Chang H-L, Sheu C-C. Antibiotic strategies and clinical outcomes in critically ill patients with pneumonia caused by carbapenem-resistant Acinetobacter baumannii. Clin Microbiol Infect. 2018;24(8):908. e1-. e7.
Katip W, Uitrakul S, Oberdorfer P. A comparison of colistin versus colistin plus meropenem for the treatment of carbapenem-resistant Acinetobacter baumannii in critically ill patients: a propensity score-matched analysis. Antibiotics. 2020;9(10):647
McKenzie C. Antibiotic dosing in critical illness. J Antimicrob Chemother. 2011;66(2):25-31.
Cotta MO, Roberts JA, Lipman J. Antibiotic dose optimization in critically ill patients. Med Intensiva. 2015;39(9):563-72.
Shahrami B, Sharif M, Sefidani Forough A, Najmeddin F, Arabzadeh AA, Mojtahedzadeh M. Antibiotic therapy in sepsis: No next time for a second chance! J Clin Pharm Ther. 2021;46(4):872-6.
Martinez ML, Plata-Menchaca EP, Ruiz-Rodriguez JC, Ferrer R. An approach to antibiotic treatment in patients with sepsis. J Thorac Dis. 2020;12(3):1007-21.
Dugar S, Choudhary C, Duggal A. Sepsis and septic shock: Guideline-based management. Cleve Clin J Med. 2020;87(1):53-64.
Sendagire C, Lipnick MS, Kizito S, Kruisselbrink R, Obua D, Ejoku J, et al. Feasibility of the modified sequential organ function assessment score in a resource-constrained setting: a prospective observational study. BMC Anesthesiol. 2017;17(1):12.
Öz E, Saltürk C, Karakurt Z, Adıgüzel N, Güngör G, Devran Ö, et al. Risk factors for multiorgan failure and mortality in severe sepsis patients who need intensive care unit follow-up. Tuberkuloz ve toraks. 2015;63(3):147-57.
Vélez JW, Aragon DC, Donadi EA, Carlotti AP. Risk factors for mortality from sepsis in an intensive care unit in Ecuador: A prospective study. Medicine. 2022;101(11):e29096.
Harris PNA, Tambyah PA, Lye DC, Mo Y, Lee TH, Yilmaz M, et al. Effect of piperacillin-tazobactam vs meropenem on 30-day mortality for patients with E. coli or Klebsiella pneumoniae bloodstream infection and ceftriaxone resistance: a randomized clinical trial. JAMA. 2018;320(10):984-94.
Kim YJ, Kim SI, Hong KW, Kim YR, Park YJ, Kang MW. Risk factors for mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia: impact of appropriate antimicrobial therapy. J Korean Med Sci. 2012;27(5):471-5.
Downloads
Published
How to Cite
Issue
Section
License
All articles published and information contained in this journal such as text, graphics, logos and images is copyrighted by and proprietary to the Thai Bulletin of Pharmaceutical Sciences, and may not be reproduced in whole or in part by persons, organizations, or corporations other than the Thai Bulletin of Pharmaceutical Sciences and the authors without prior written permission.
