Effects of meropenem supply restriction: A multicenter retrospective study.

IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Journal of Infection and Chemotherapy Pub Date : 2024-07-18 DOI:10.1016/j.jiac.2024.07.015
Yoshimichi Koutake, Yoji Nagasaki, Ryosuke Hirata, Keiji Soejima, Hiromi Nishi, Hiroko Tsukada, Shohei Hamasaki, Masashi Hashimoto
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Abstract

Background: In Japan, the supply of one generic meropenem product was restricted from August 2022 to March 2023.

Objective: To determine the effects of meropenem (MEPM) restriction.

Methods: We conducted a multicenter retrospective study comparing antimicrobial use, bacteremia mortality, and drug-resistant bacteria detected before the restriction of MEPM (control period), from September 2021 to February 2022, and after the restriction of MEPM (MEPM supply restriction period), from September 2022 to February 2023, in five institutions.

Results: The number of carbapenem days of therapy (DOTs) were decreased in all five institutions. Fourth-generation cephalosporin DOTs increased in all facilities, and piperacillin/tazobactam DOTs increased in four facilities. The 30-day and 90-day mortality rates were significantly higher during the MEPM supply restriction period than those during the control period. Moreover, survival time was significantly shorter during the MEPM supply restriction period than that during the control period. Multivariable analysis revealed that MEPM supply restriction, age >80 years, Pitt Bacteremia Score ≥4, platelet count <10 × 104/μL, serum albumin level <2.5 g/dL, and methicillin-resistant Staphylococcus aureus bloodstream infection were independent risk factors for 30-day mortality. The detection rates of carbapenem-resistant Pseudomonas aeruginosa and Enterobacteriaceae did not differ significantly between the two periods.

Conclusions: MEPM supply restriction decreased the use of carbapenems and increased the use of other broad-spectrum antimicrobial agents, which worsened the prognosis of bacteremia. Overall, carbapenems are important drugs for the treatment of infectious diseases and are difficult to replace in unforeseen situations such as drug supply outages.

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限制美罗培南供应的影响:一项多中心回顾性研究。
背景:日本从 2022 年 8 月至 2023 年 3 月限制供应一种美罗培南仿制药日本从 2022 年 8 月至 2023 年 3 月限制一种美罗培南仿制药的供应:确定美罗培南(MEPM)限制的影响:我们进行了一项多中心回顾性研究,比较了2021年9月至2022年2月美罗培南限制前(对照期)和2022年9月至2023年2月美罗培南限制后(美罗培南供应限制期)五家机构的抗菌药物使用情况、菌血症死亡率和耐药菌检出情况:结果:所有五家机构的碳青霉烯类药物治疗天数(DOT)均有所减少。所有机构的第四代头孢菌素 DOT 天数均有所增加,4 家机构的哌拉西林/他唑巴坦 DOT 天数有所增加。在限制 MEPM 供应期间,30 天和 90 天的死亡率明显高于对照期间。此外,限制 MEPM 供应期间的存活时间明显短于对照期间。多变量分析显示,限制 MEPM 供应、年龄大于 80 岁、皮特菌血症评分≥ 4、血小板计数小于 10×104/μL、血清白蛋白水平小于 2.5 g/dL、耐甲氧西林金黄色葡萄球菌血流感染是 30 天死亡率的独立风险因素。耐碳青霉烯类铜绿假单胞菌和肠杆菌科细菌的检出率在两个时期没有显著差异:结论:限制 MEPM 的供应减少了碳青霉烯类药物的使用,增加了其他广谱抗菌药物的使用,从而恶化了菌血症的预后。总之,碳青霉烯类是治疗感染性疾病的重要药物,在药物供应中断等意外情况下难以替代。
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来源期刊
Journal of Infection and Chemotherapy
Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY
CiteScore
4.10
自引率
4.50%
发文量
303
审稿时长
47 days
期刊介绍: The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.
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