Administration of meropenem for the treatment of ventilator-associated pneumonia

Introduction

Ventilator-associated pneumonia (VAP) is associated with the greatest mortality among nosocomial infection. Death rates associated with Pseudomonas spp. or with late-onset VAP seem higher. Treatment of these infections is frequently complicated by antibiotic resistance, a problem that has been increasing in recent years.

Objective and methods

The goal of the study was to evaluate the clinical efficacy of meropenem by continuous infusion administration (CIA) or by bolus intermittent infusion (BII) for the treatment of VAP caused by Pseudomonas aeruginosa. An historic control group with VAP caused by P. aeruginosa who received initial empiric antibiotic therapy with meropenem by BII (n = 32) was compared with a prospective cohort treated with meropenem by CIA (n = 20) in a 12-bed surgical ICU, at a 400-bed surgical complex of a district hospital. We looked for demography, APACHE II score, mortality, attributable mortality for VAP, days on mechanical ventilation (MV), and ICU length of stay. VAP was treated during 14 days with meropenem (1 g/6 hours intravenously). The antibiotic clinical effect was categorized as cure or failure. Difference between groups were tested by means of Student's t test end exact chi-square test, using the MedCalc program. We consider values of P < 0.05 as a significant difference.

Results

Significant differences were not found between both groups of patients in sex, age, APACHE II score, and diagnosis. The CIA group showed significantly greater clinical cure than the BII group (CIA 18/20 (90%) vs BII 21/32 965.6%), P = 0.041) and smaller but not significant attributable mortality to VAP (2 of 20 (10%) vs 10 of 32 (31.3%), P = 0.288).

Conclusion

Our results suggest that administration of meropenem by CIA may have more clinical efficacy than administration by BII for the treatment of VAP, but more studies are required to confirm this.