Evaluation of Empirical Meropenem Bolus Protocol in Pseudomonas aeruginosa: A Three-Year Analysis in Tertiary Intensive Care Unit

Figures & data

Table 1 Demographic and Clinical Characteristics

	N	%
Sex
- Male	93	68.9
- Female	42	31.1
Primary diagnosis
- Cardiovascular	5	3.7
- Digestive surgery	17	12.6
- Internal medicine	19	14.0
- Neurology	6	4.4
- Neurosurgery	43	32.0
- Gynecology	3	2.2
- Oncology	6	4.4
- Orthopedic	15	11.1
- Plastic surgery	1	0.7
- Pulmonology	4	3.0
- Thorax surgery	8	6.0
- Urology	7	5.2
- Vascular surgery	1	0.7
Comorbidities
- Sepsis	9	4.4
- Malignancy	27	13.2
- Cerebrovascular disease	14	6.8
- Kidney failure	10	4.9
- Cardiovascular disease	12	5.9
- Invasive procedure or surgery	99	48.3
- Trauma	34	16.6
Specimen
- Sputum	99	73.4
- Urine	11	8.1
- Wound	14	10.4
- Tissue	1	0.7
- Pus	2	1.5
- Pleural fluid	3	2.2
- Blood	5	3.7

Table 2 Meropenem Use

	N (%) or Mean±SD
Empirical therapy
- Yes	33 (24.4)
- No	102 (75.6)
Dosage
- Standard-dose	29 (87.9)
- High-dose	4 (12.1)
Exposure (days)	9.9±4.0
Duration (days)	12.3±7.1

Figure 1 Trends of meropenem susceptibility rates for P. aeruginosa isolated from the ICU and hospital-wide. (Dashed trendline represents moving average of two consecutive study periods in hospital susceptibility rate).

Figure 2 Number of P. aeruginosa isolates collected to generate susceptibility trends in ICU and hospital. (Dashed horizontal gridline indicates the minimum threshold for number of isolates [n = 30]).

Figure 3 Trend of multidrug-resistant P. aeruginosa rate. (Dashed trendline represents moving average of two consecutive study periods).

Table 3 Analysis of Risk Factors for Meropenem Nonsusceptibility

Risk Factors	Nonsusceptibility		p
	Yes (N=50)	No (N=85)
Age (years)	54.8±14.9	49.4±18.5	0.08
Exposure (days)	9.9±4.1	9.3±3.8	0.76
Duration (days)	12.5±7.5	10.5±2.1	0.60
Males	34 (36.6)	59 (63.4)	1
Sepsis	6 (66.7)	3 (33.3)	0.08
Malignancy	7 (25.9)	20 (74.1)	0.27
Cerebrovascular disease	6 (42.9)	8 (57.1)	0.77
Chronic kidney disease	4 (40)	6 (60)	1
Cardiovascular disease	6 (50)	6 (50)	0.36
Invasive procedure or surgery	35 (35.4)	64 (64.6)	0.55
Trauma	15 (44.1)	19 (55.9)	0.41
Empirical therapy	29 (87.9)	4 (12.1)	<0.001*
Standard-dose administration	25 (86.2)	4 (13.8)	1

Notes: Data expressed in mean±SD or counts (percentage). *Indicates statistically significant p values.

Table 4 Multivariate Logistic Regression Analysis Identifying Independent Risk Factors for Meropenem Nonsusceptibility

Variable	Adjusted OR (95% CI)	p
Age	0.97 (0.95–1)	0.053
Sepsis	1.46 (0.25–8.51)	0.671
Empirical therapy	30.65 (9.19–102.23)	<0.001*

Note: *Indicates statistically significant p values.