Real-time TDM-based optimization of continuous-infusion meropenem for improving treatment outcome of febrile neutropenia in oncohaematological patients: results from a prospective, monocentric, interventional study.

The Journal of Antimicrobial Chemotherapy
Pier Giorgio CojuttiFederico Pea

Abstract

To assess the role that real-time therapeutic drug monitoring (TDM)-guided optimization of continuous-infusion (CI) meropenem may have in maximizing empirical treatment and in preventing breakthrough infection and/or colonization with carbapenem-resistant Enterobacteriaceae (CRE) among oncohaematological patients with febrile neutropenia (FN). A monocentric, interventional, prospective study was conducted. The pharmacodynamic (PD) target was a steady-state meropenem concentration-to-MIC ratio (Css/MIC) of 4-8. The primary endpoint was 14 day all-cause mortality. The secondary endpoint was the prevalence of CRE colonization in rectal swabs of patients rehospitalized within 3 months. Among the 75 patients enrolled, most (56%) had AML, almost half (37/75, 49.3%) underwent HSCT and one-third (32%) received meropenem as monotherapy. Meropenem dosages were adjusted in 30.1% of TDM reassessments. Gram-negative infections were microbiologically documented in 20.0% of patients. All of the 12 patients having infections caused by in vitro meropenem-susceptible pathogens attained the desired PD target and were cured. Three patients had infections caused by in vitro meropenem-resistant pathogens. Two of these achieved a Css/MIC target of 1 ...Continue Reading

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Citations

Feb 4, 2021·Journal of Clinical Pharmacy and Therapeutics·Nadine A SteffensNatália Brucker
Jan 23, 2021·Pharmacotherapy·Andrew J FratoniJoseph L Kuti
Jan 31, 2021·International Journal of Antimicrobial Agents·Albrecht EisertTim-Philipp Simon
Feb 12, 2021·Clinical Pharmacology and Therapeutics·Cornelia B Landersdorfer, Roger L Nation
Jul 16, 2021·Current Opinion in Infectious Diseases·Milo Gatti, Federico Pea

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