Combating bacterial resistance to Meropenem by infusion strategy applied to septic burn patients with vasopressor requirements or acute kidney injury to achieve the target

• DOI: 10.15406/ppij.2024.12.00439
• Publication Date: 2024-07-23T05:34:10Z
• Authors: Silvia R C J Santos; Thais Vieira de C...; Karina Brandt Vianna; Leonard de Vinci ...; Beatriz Aparecida...; Mauricio Yonamine; Valentina Porta; Aline Sandre Gomi...; Gabriela Aparecid...; Thiago de Oliveir...; Débora C Sanches ...; Edvaldo Vieira de...; João Manoel da Si...; David de Souza Gomez
• Keywords: 0301 basic medicine; 03 medical and health sciences

Introduction: Faced with the growing challenge to use of antimicrobials for adequate and effective therapy nosocomial infections, international health agencies have reinforced that combating bacterial resistance preventing development multidrug-resistant (MDR) strains are urgent, since a significant increase based on minimum inhibitory concentration (MIC) therapeutic agents were reported by committee hospitals infection. Meropenem, carbapenem agent, is widely prescribed septic shock caused susceptible Gram-negative bacteria. In general, prolonged 3-hrs-infusion has been applied in these patients over past 10 years providing coverage only against pathogens (MIC 2 mg/L), extended also intermediate up MIC 4 mg/L, according Clinical Laboratory Standard Institute (CLSI database). However, new strategies recommended combat isolated from cultures this agent 8 avoid mutant selection death ICU. Subject: protocol was carried out investigate efficacy & safety meropenem at dose regimen 1g q8h infusion, serum levels monitoring isolates. Aim assess pharmacodynamics (PD) changes pharmacokinetics (PK), which could affect burns increased or decreased renal function. Pharmacokinetic-pharmacodynamics (PK/PD) tools safety. Methods-clinical protocol: Forty-eight major burn high variability function ICU included. Cultures collected before starts; all them had infection isolated. Patients undergoing initial stage day-0 day-8 (D0-D8) late day 14 (D-8 D-14) investigated requirements creatinine clearance, drug (TDM), dependent Results: Coverage occurred both groups after infusion mg/L (minimum concentration), susceptibility, Standards (CLSI, database) our hospital. It demonstrated augmented vasopressors, superiority trice 24/27 (89%) hrs.-infusion TDM3 comparison registered 12/39 (30%) 3 TDM2. On other hand, must be adjusted q24h AKI guarantee effectiveness those patients. addition, continuous venovenous haemodialysis-filtration (CVVHDF) installed patients, PK/PD target attained empirical q8h, 3hrs.-infusion. Conclusion: Precision medicine guarantees combined monitoring; consequently, routinely including susceptibility 4-8 mg/L) selection. Therefore, effective, safe antimicrobial shock, inflammatory biomarkers, should guide clinical management ensure cure early discharge.