FACTORS AFFECTING MEROPENEM TROUGH LEVELS IN CRITICALLY ILL PATIENTS: A THERAPEUTIC DRUG MONITORING STUDY

Öz

Objective: This study primarily aimed to determine meropenem the trough level (C_min) in intensive care unit (ICU), with an exploratory secondary aim of evaluating factors influencing C_min and clinical cure.

Material and Method: This prospective study included adult ICU patients receiving meropenem for ≥48 hours, and C_min levels were measured using a ready-to-use ELISA kit.

Result and Discussion: The study included 38 patients, 26 of whom were male. Mean meropenem C_min value was found to be 0.40 ± 0.07 mg/l which is statistically different than the target value of 8 mg/l (p < 0.001). We found no statistically significant difference in mean C_min between the patient groups whose creatinine clearance was smaller than 50 ml/min and not. Erythrocyte and hemoglobin values decreased after meropenem treatment compared to baseline (p < 0.05). C-Reactive Protein (CRP) decreased, and Sequential Organ Failure Assessment (SOFA) values increased after meropenem treatment (p < 0.001). Logistic regression in patients with Systemic Inflammatory Response Syndrome (SIRS) showed that only SOFA reduced the clinical cure rate (OR 0.534, 95% CI 0.311–0.917). In this study, the target 100% fT > MIC < 4×MIC was not achieved with standard or extended meropenem infusion, potentially limiting clinical cure in ICUs with resistant pathogens, highlighting the need for alternative dosing strategies.

Anahtar Kelimeler

• Drug trough level
• intensive care unit
• meropenem
• therapeutic drug monitoring

KRİTİK HASTALARDA MEROPENEM SEVİYELERİNİ ETKİLEYEN FAKTÖRLER: TERAPÖTİK İLAÇ İZLEME ÇALIŞMASI

Öz

Amaç: Bu çalışmanın öncelikli amacı yoğun bakım ünitesinde (YBÜ) meropenem çukur seviyesini (C_min) belirlemek, ikincil amacı ise C_min ve klinik iyileşmeyi etkileyen faktörleri değerlendirmektir.

Gereç ve Yöntem: Bu prospektif çalışmaya, ≥48 saat meropenem alan yetişkin yoğun bakım hastaları dahil edildi ve Cmin düzeyleri hazır kullanıma uygun ELISA kiti ile ölçüldü.

Sonuç ve Tartışma: Çalışmaya 26’sı erkek toplam 38 hasta dahil edildi. Ortalama meropenem Cmin değerinin 0.40 ± 0.07 mg/l olduğu bulundu; bu değer, hedef değer olan 8 mg/l'den istatistiksel olarak farklıdır (p < 0.001). Kreatinin klirensi 50 ml/dk'dan az olan ve olmayan hasta grupları arasında ortalama C_min açısından istatistiksel olarak anlamlı bir fark bulunmadı. Meropenem tedavisi sonrası eritrosit ve hemoglobin değerleri başlangıç değerlerine göre azaldı (p < 0.05). Meropenem tedavisi sonrasında C-reaktif protein (CRP) azaldı ve Sekansiyel Organ Yetmezliği Değerlendirmesi (SOFA) değerleri arttı (p < 0.001). Sistemik İnflamatuvar Yanıt Sendromu (SIRS) olan hastalarda yapılan lojistik regresyon analizinde yalnızca SOFA’nın klinik iyileşme oranını düşürdüğü görüldü (OR 0.534, %95 CI 0.311–0.917). Çalışmamızda, standart veya uzatılmış meropenem infüzyonu ile hedeflenen 100% fT >MIC < 4×MIC sağlanamadı; bu durum, dirençli patojenlerin sık görüldüğü yoğun bakım ünitelerinde klinik iyileşmeyi sınırlayabilir ve alternatif dozlama stratejilerinin geliştirilmesi gerektiğini göstermektedir.

Anahtar Kelimeler

• İlaç çukur düzeyi
• meropenem
• terapötik ilaç izlemi
• yoğun bakım ünitesi

Kaynakça

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