Evaluation of appropriateness of meropenem treatment and outcomes among internal medicine patients in Thailand

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OBJECTIVE: Carbapenems are commonly used empirically in referral hospitals; however, the appropriateness and outcomes of meropenem use in regional settings with rising multidrug resistance remain unclear. METHODS: A retrospective cohort study of 528 patients who received at least 1 dose of meropenem in the internal medicine ward at Lampang hospital, Thailand during the study period (1 August 2022 and 31 December 2022). RESULTS: A total of 528 patients were enrolled. Of these, 281 (53.22%) were survivors, while 247 (46.78%) were non-survivors. Gram-negative bacteria were the most common infections, with 28.2% susceptible to carbapenems. The most frequent pathogens were Acinetobacter baumannii (16.7%), followed by Escherichia coli (13.6%) and Klebsiella spp. (8.0%). Pneumonia (36.93%) and urinary tract infection (21.97%) were the most common sites of infection. Appropriate empirical meropenem use was significantly more frequent among survivors than among non-survivors (93.7% vs. 87.4%; p = 0.020). Additionally, appropriate targeted meropenem therapy was administered in 13.96% of cases and was significantly more frequent among survivors than non-survivors (18.40% vs. 9.91%; p < 0.001). Multivariate analysis identified higher SOFA score and multiorgan dysfunction-particularly respiratory failure-as independent risk factors for 30-day all-cause mortality; respiratory tract infection and shorter length of hospital stay were also associated with mortality. Survivors had a significantly longer hospital stay than non-survivors (5.92 vs. 3.61 days; p = 0.007) and a higher microbiological cure rate (40.21% vs. 23.89%; p < 0.001). CONCLUSION: Although appropriate antibiotic coverage was more frequently observed among patients with favorable outcomes, severity of illness and organ dysfunction remained the primary determinants of survival. Appropriate empirical and targeted therapy, alongside optimal critical care management, should be emphasized in the treatment of these severe infections in regional settings.

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