International Journal of General Medicine (Nov 2021)
Evaluation of Empirical Meropenem Bolus Protocol in Pseudomonas aeruginosa: A Three-Year Analysis in Tertiary Intensive Care Unit
Abstract
I Wayan Suranadi,1 Putu Agus Surya Panji,1 Ni Nyoman Sri Budayanti,2 Tjokorda Gde Agung Senapathi,1 Arif Budiman Susatya1 1Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Denpasar, Bali, 80113, Indonesia; 2Department of Clinical Microbiology, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, 80113, IndonesiaCorrespondence: I Wayan SuranadiDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Diponegoro Street, Dauh Puri Klod, Denpasar, 80113, IndonesiaTel/Fax +62361-227911Email [email protected]: To describe meropenem empirical use, susceptibility trend, and associated factors for acquired nonsusceptibility in P. aeruginosa in the intensive care unit.Patients and Methods: This study was conducted in the intensive and high care unit of a tertiary care hospital in Indonesia to evaluate empirical meropenem bolus administration protocol. All patients admitted during the 3 year study period from January 2018 through January 2021 with culture-confirmed P. aeruginosa infection were included in the study. Primary data were collected from hospital database electronic medical record and series of local biannual report of microorganism susceptibility pattern.Results: The data suggested that there was increasing trend in meropenem nonsusceptibility and multidrug-resistance rates. A total of 135 patients with various primary diagnoses and comorbidities were studied. P. aeruginosa isolates were mostly (73.4%) obtained from sputum specimen. Empirical meropenem therapy was administrated in 24.4% of patients with standard- and high-dose as indicated. Nonsusceptibility was acquired in 37% patients who mostly received empirical therapy. Multivariable analysis revealed protocol being evaluated as a statistically significant risk factor for nonsusceptibility in P. aeruginosa (PR = 30.65; p < 0.001).Conclusion: Empirical meropenem administration protocol in this study was an independent determinant of nonsusceptibility acquisition in P. aeruginosa. These findings proved that empirical therapeutic strategy modification is indispensable and routine evaluation practice should be promulgated.Keywords: antibiotic resistance, critical care, empirical therapy, Indonesia, meropenem, Pseudomonas aeruginosa
