A Randomized Controlled Clinical Trial Of Extending Infusion Time Of Meropenem In Treatment Of Severe Bacterial Infections In Critically â…¢ Patients

Objective:To compare clinical efficacy and safety of meropenem administered by extending infusion time to3hours and intermittent bolus infusion to30minutes to critically ill patients with serious bacterial infections.Materials and Methods:Open randomized controlled study. One hundred and twenty patients with severe bacterial infections admitted to ICU(from2012.9.1to2013.9.31) were randomized to the experimental group (3h-infusion group) and the control group (30min-infusion group). Meropenem were administered in accordance with250mg/10min/+750mg/180min in the experimental group and1000mg/30min in the control group. On the day before the use of meropenem and the fourth day, the eighth day during the treatment and the day after meropenem withdrawing, the clinical information were recorded, such as temperature, number of WBC/PCT/CRP, image, oxygenation index, liver and kidney functions, bacteria cultures and drug sensitiveness test. Adverse reactions, APACHE Ⅱ/SOFA score, number of index for SIRS, classification of PSI risk were also recorded. The clinical efficacy, comprehensive efficacy, bacterial clearance rate, improvement of scoring system of severe diseases, and adverse reaction were compared between the two group.Results:One hundred and eight patients completed the research with fifty two in3h group and fifty six in30min group. There were significant differences in clinical efficacy (78.8%vs.50%),twenty-eight days survival rate(86.5%vs.66.1%) and mortality in Intensive Care Unit(9.6%vs.25%) between3h group and30min group. A better improvement of SOFA Score was observed in3h group(2.31±2.58vs.1.09±2.27). There were no differences in Bacterial clearance rate(48.7%vs.47.7%),Comprehensive efficacy(55.8%vs.39.3%), effective absorption rate of Imaging(50%v5.32.1%),MV days(10.85±10.44v.s.12.06±7.37),ICU stays(19.98±12.35vs.20.61±9.44) and improvement of clinical signs, infection markers and scores for critical diseases between the two group. In the lung infection subgroup, the clinical cure rate,28days survival rate, improvement of SIRS indicators, SOFA score and CPIS score, were significantly better than the control group. In the abdominal infection subgroup, the clinical cure rate was better than the control group. A similar adverse reaction of light to moderate elevation of liver enzymes was observed in both group, which recovered after withdrawing meropenem without special treatment.Conclusions:For ICU patients with serious infection, extending infusion time of meropenem to3h could improve the clinical efficacy and28-day survival rate, promote the recovery of organ failure with no increase in adverse reactions.