Jason Yerke, BCCCP, PharmD
Medical ICU Clinical Pharmacy Specialist
Cleveland Clinic Foundation
Cleveland, Ohio
Disclosure information not submitted.
Andrea Pallotta, PharmD, BCPS, BCIDP, AAHIVP
Infectious Diseases Clinical Pharmacist
Cleveland Clinic, United States
Disclosure information not submitted.
Heather Heiney, PharmD, BCCCP
Critical Care Clinical Pharmacist
Cleveland Clinic, United States
Disclosure information not submitted.
Xin Zou, PharmD, BCPS
Critical Care Clinical Pharmacist
Cleveland Clinic, United States
Disclosure information not submitted.
Thomas Fraser, M.D.
Infectious Diseases Physician
Cleveland Clinic, Ohio, United States
Disclosure information not submitted.
Anita Reddy, MBA, MD, FCCM
Medical Intensive Care Unit Physician, Associate Director of ICU Operations
Cleveland Clinic
Cleveland, Ohio, United States
Disclosure information not submitted.
Title: Patterns of meropenem prescribing in the intensive care units of a large academic medical center
Introduction/Hypothesis: Inappropriate antimicrobial prescribing is a rampant concern in hospitals. Carbapenem exposure is particularly concerning as it is a risk factor for development of infections caused by carbapenem-resistant organisms, which carry a high mortality burden compared to infections caused by carbapenem-susceptible organisms. Antibiotic choice and duration are also risk factors for C. difficile infection. We sought to assess patterns of meropenem prescribing in intensive care units (ICU) at our site to identify areas for implementation of antimicrobial stewardship.
Methods: All patients prescribed meropenem from March to May 2021 in any ICU at the study center were assessed for inclusion. Any patient that received meropenem as their first anti-pseudomonal beta-lactam (APBL) or that was escalated to meropenem from piperacillin/tazobactam (PT) or cefepime within 48 hours was included. Culture data, duration of therapy, and the reason for choosing meropenem rather than an alternative were collected.
Results: Two hundred forty-seven patients were included (147 that received meropenem as their first APBL and 100 that were escalated to meropenem from a narrower APBL within 48 hours). The most common reasons meropenem was used as the first APBL were penicillin allergy (37.4%) and empirically (40.8%). Of the included patients with penicillin allergy, only 16.4% received penicillin allergy skin testing. Patients were most commonly escalated to meropenem from an alternate APBL empirically (74%). Patients empirically treated with meropenem as the first APBL or escalated to meropenem empirically grew a PT resistant, meropenem-susceptible organism in a culture in 8/134 instances (6.0%). Of the patients in this subset that cultured a potential pathogen, 8/48 pathogens (16.7%) were PT-resistant, meropenem-susceptible.
Conclusions: These data suggest that empiric meropenem, whether as the first APBL or escalation from another APBL, is a low-yield intervention in those without a history of PT resistant pathogens. Historically, addition of an aminoglycoside to PT or cefepime has covered more resistant pathogens than an expansion to meropenem from PT or cefepime at our institution. Additionally, expansion of our inpatient penicillin allergy skin testing program could result in significantly reduced meropenem usage.