Predictors of Treatment Failure and Mortality among Patients with Septic Shock Treated with Meropenem in the Intensive Care Unit

Abstract

Background: The aim of the study was to determine the predictors of meropenem treatment failure and mortality in the Intensive Care Unit (ICU). Methods: This was a retrospective study, involving sepsis and septic shock patients who were admitted to the ICU and received intravenous meropenem. Treatment failure is defined as evidence of non-resolved fever, non-reduced total white cell (TWC), non-reduced C-reactive protein (CRP), subsequent culture negative and death in ICU. Results: An Acute Physiology and Chronic Health Evaluation II (APACHE II) and duration of antibiotic treatment less than 5 days were associated with treatment failure with adjusted OR = 1.24 (95% CI: 1.15, 1.33; P < 0.001), OR = 65.43 (95% CI: 21.70, 197.23; P < 0.001). A higher risk of mortality was observed with higher APACHE and Sequential Organ Failure Assessment (SOFA) scores, initiating antibiotics > 72 h of sepsis, duration of antibiotic treatment less than 5 days and meropenem with renal adjustment dose with an adjusted OR = 1.21 (95% CI: 1.12, 1.30; P < 0.001), adjusted OR = 1.23 (95% CI: 1.08, 1.41; P < 0.001), adjusted OR = 6.38 (95% CI: 1.67, 24.50; P = 0.007), adjusted OR = 0.03 (95% CI: 0.01, 0.14; P < 0.001), adjusted OR = 0.30 (95% CI: 0.14, 0.64; P = 0.002). Conclusion: A total of 50 (14.12%) patients had a treatment failure with meropenem with 120 (48.02%) ICU mortality. The predictors of meropenem failure are higher APACHE score and shorter duration of meropenem treatment. The high APACHE, high SOFA score, initiating antibiotics more than 72 h of sepsis, shorter duration of treatment and meropenem with renal adjustment dose were predictors of mortality.

Analytical Evaluation of Point-of-Care Finecare™ Procalcitonin Rapid Quantitative Test in Sepsis Population as Compared with Elecsys® BRAHMS Procalcitonin Immunoassay

“…In our institution’s mixed ICU ward, the majority of cases were sepsis, with an incidence of about 48% and a mortality rate of 28% recorded in 2019 [ 12 ]. The causes of sepsis are mainly due to hospital-acquired pneumonia (50.28%), followed by community-acquired pneumonia (CAP) (20.3%), intra-abdominal infection (15.3%), necrotizing fasciitis (8.2%), urosepsis (3.4%), and meningitis (2.5%) [ 13 ]. Meropenem antibiotic was commonly prescribed in our ICU due to the majority of patients presenting with septic shock and high Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores while waiting for culture [ 13 ].…”

“…The causes of sepsis are mainly due to hospital-acquired pneumonia (50.28%), followed by community-acquired pneumonia (CAP) (20.3%), intra-abdominal infection (15.3%), necrotizing fasciitis (8.2%), urosepsis (3.4%), and meningitis (2.5%) [ 13 ]. Meropenem antibiotic was commonly prescribed in our ICU due to the majority of patients presenting with septic shock and high Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores while waiting for culture [ 13 ]. The determination to use meropenem needs to be based on a balance between considerations of the severity of the sepsis and the inappropriate use of a broad-spectrum antibiotic that can lead to the emergence of a resistance organism.…”