Routine dosage of meropenem (MER) seems attractive to optimize the pharmacodynamic goal of > 40% time above MIC (40% T>MIC), particularly in difficult to treat infections and/or in ICU patients (pts).
We performed a retrospective study of serum concentrations of MER required by infectiologists (INF) and non infectiologists (nonINF) physicians for bacteriological documented infections with MIC, during a 3.5 years period of time.
A total of 98 measurements were available in 54 pts with 56 episodes of infections(EPI). All were nosocomial infections (HAP and VAP 54% ; complicated intraabdominal infections 25% ;osteoarticular infections 7% ; others 14%) and 77% (43/56) occured in ICU. Dosages were ordered by INF in 65% (64/98), representing 45% (25/56) of total EPI and 30% (13/43) of EPI in ICU. The number of dosages/ EPI was higher when asked by INF than by nonINF (2.5 ± 1.7 vs 1.2 ± 0.45 respectively, p < 0.001). A single measurement (SM) occured in 66% (37/56) EPI : 40% for INF and 87% for nonINF, p< 0.005. In cases of SM, dosage was not interpretable in 33% (12/37) when asked by nonINF and 0% when asked by INF, respectively, mainly due to wrong timing (before steady state in 82%). Infection was the cause of death in 13 pts: all of them had SM. Among 44 interpretable EPI, estimated > 40% T>MIC was achieved in 93%, but this was not correlated with clinical evolution, death, bacterial eradication or physicians requiring measurements (INF vs nonINF).
SM of MER is related to unability to interpret dosages, death and request from nonINF. A closer collaboration is thus needed between INF and nonINF to improve the use of antibiotics measurements.
R. Denooz, None
C. Charlier, None
S. Vanbelle, None
P. Damas, None
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