Carbapenem Utilization in Critically Ill Patients
AbstractBackground: Drug Utilization Evaluation (DUE) studies are designed to evaluate and improve the rational use of medications. DUEs have focused on drugs used in high risk patients such as critically ill cases in this study. Carbapenems are beta-lactam type antibiotics with broad-spectrum of activity which cover Gram-positive, Gram-negative and anaerobic bacteria. The heavy use of carbapenems (imipenem or meropenm) could increase the risk of multi-drug resistant (MDR) pathogens.Methods: This study was a prospective and cross sectional study performed at three intensive care units (ICUs) of Shariati hospital, affiliated with Tehran University of Medical Sciences. The study was conducted from April 2012 to May 2013. All of the patients were on imipenem or meropenem as an empiric treatment or based upon microbiology culture results included in the study.Results: Total of 68 patients in three ICU wards evaluated. The most common diagnosis was Central Nervous System (CNS) infections and meningitis (36.8%). The most common microorganism derived from the patient’s specimen was Acinetobacter spp. (28%). Overall initial treatment for thirty five patients (51.4%) was justified versus nineteen cases (27.9%) of unjustified. For 14 patients (20.5%) empiric treatment was justified, but continuation of treatment was unjustified.Conclusion: The result of the study showed that empiric therapy was justified in most cases (72%), but according to the culture results, continuation of treatment in several cases was unjustified (47%).
Russia Rational Pharmaceutical Management Project. Guidelines for implementing drug utilization review programs in hospitals. Arlington, VA/Moscow. Management Sciences for Health website [cited January 1997] Available from: URL: http://dmsic.moph.go.th/download/DUR_ guidelines.pdf
Zhanel GG, Johanson C, Embil JM, et al. Ertepenem: Review of a new carbapenem. Expert Rev Anti Infect Ther 2005; 3(1): 23.
Sakhaiyan E, Hajibabaie M, Gholami Kh, et al. Drug utilization review of imipenem in patients undergoing bone marrow transplantation. IJHOSCR 2009; 3(2):10-11.
Mohr JF. Update on the efficacy and tolerability of meropenem in the treatment of serious bacterial infections. Clin Infect Dis. 2008; 47 (1):41-2.
McEvoy GK. AHFS drug information 2007. Revised edition (February 2007). Maryland: American society of health system pharmacist; 2008.
Akinci E, Colpan A, Bodur H, Balaban N, Erbay A. Risk factors for ICUacquired imipenem resistant gram-negative bacterial infections. J Hosp Infect 2005; 59:317.
Solomkin JS, Mazuski JE, Bradley JS. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the surgical infection society and the infection diseases society of America. Clin Infect Dis 2010; 50:133-154.
American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital acquired, ventilator associated and healthcare associated pneumonia. Am J Respir Crit Care Med 2005; 171: 388-407.
Thuong M, Shortgen F, Zazempa V, Girou E, Soussy CJ, Brun-Buisson C. Appropriate use of restricted antimicrobial agents in hospitals: the importance of empirical therapy and assisted re-evaluation. J Antimicrobial Chemother 2000; 46(3):501-8.
Raveh D, Muallem-zilcha E, Greenberg A, Wiener-Well Y, Schlesinger Y, Yinnon AM. Prospective drug utilization evaluation of three broad-spectrum antimicrobials: cefepime, piperacillin-tazobactam and meropenem. QJM 2006: 99(6):397-406.
Bowman L, External Doctor of pharmacy program. Hosp. Pharm.1996 [cited 2007 May 12] Available from: URL: http://depts.washington.edu/ expharmd/ExpharmD_DUE.html
Belognia EA, Schwarts B. Strategies for promoting Judicious Use of antibiotics by Doctors and Patients. BMJ 1998; 317(7159):668-71.
Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39(1):1267-84.
Hayatshahi A, Javadi M, Torkamandi H, et al. Drug utilization review of conventional Amphotericin B in febrile neutropenic patients hospitalized in a bone marrow transplantation center. IJHOSCR 2010; 4(2):1-3.
Hayatshahi A, Javadi M, Torkamandi H, et al. Drug utilization review of Vancomycin in febrile neutropenic patients hospitalized at a bone marrow transplantation center. IJHOSCR 2010; 4(3):10-13.