Optimización con criterios PK/PD de la terapia con meropenem en el paciente crítico. Análisis farmacoeconómico de resultados

Meropenem is a broad-spectrum antibiotic. It is a drug usually reserved for the treatment of infections caused by multi-drug resistant microorganisms or in the empirical treatment of patients with risk factors for multi-drug resistant microorganisms. Therefore, its use is frequent in intensive care units (ICU). Critical patients features including physiopathological and pharmacokinetic changes and infected by microorganisms with high minimum inhibitory concentration (MIC) make difficult calculating the optimal meropenem dose. The objective of our study was to analyze the use of clinical pharmacokinetics to optimize the therapy with meropenem in critically ill patients and assess a possible pharmacoeconomic benefit. This retrospective, observational, naturalistic, cohort single-centre study was conducted in critically ill patients treated with meropenem admitted in the ICU at a universitary hospital. Subjects were divided into two cohorts; cohort A if they had pharmacokinetic intervention or cohort B if not. For the pharmacokinetic analysis, two serum samples were drawn from each patient (a peak sampled at the end of the infusion and a sample in the elimination phase) for quantification of the total and (for some patients) free meropenem concentrations. Meropenem was administered in infusions of 3 hours theoretically. Individual pharmacokinetic parameters were estimated by the method of Sawchuk and Zaske. The percentage of time in which the free drug concentration exceeded 4 times the MIC of the isolated microorganism was estimated, and dose adjustment was made when necessary. All the variables required for the study were obtained from the electronic medical record and the pharmacokinetic history. The objectives of this study were to analyze and compare clinical and microbiological effectiveness and the safety of meropenem treatment in critically ill patients in both cohorts. We evaluated the type of pharmacokinetic interventions (IFs) recommended in monitored patients according to the real MICs of the isolated ...