Clinical and microbiological efficacy of continuous versus intermittent application of meropenem in critically ill patients

1. Clinical and microbiological efficacy of meropenem therapy were evaluated at the end of meropenem therapy
Clinical response was evaluated at the end of therapy as treatment success or failure. Clinical success was defined as complete or partial resolution of leukocytosis, temperature, and clinical signs and symptoms of infection. Cure was defined as complete resolution of all acute signs and symptoms of infection, with no new signs or symptoms associated with the original infection. Patients who retained evidence of infection but demonstrated a reduction of the majority of the clinical signs and symptoms of infection and no new or worsened signs associated with the original infection were classified as improved. For the purpose of statistical analysis, patients meeting the definitions of cured and improved were combined and defined as clinical successes. Failure consisted of any of the following:
1.1. Persistence or progression of signs and symptoms of infection
1.2. Development of new clinical findings consistent with active infection
1.3. Death from infection

2. Microbiological outcome was assigned one of the following categories: eradication, presumed eradication, persistence, presumed persistence, resistance or unevaluable. Eradication was defined as elimination of the pathogen from the site of isolation. Presumed eradication consisted of absence of appropriate material for culture or absence of results of control microbiological tests coupled with clinical improvement after a pathogen was initially isolated. Three possible outcomes were defined collectively as persistence: verified persistence (failure to eradicate the original pathogen from the site of isolation after completion of therapy), presumed persistence (absence of appropriate material for culture or absence of results of control microbiological tests coupled with lack of clinical improvement after a pathogen was initially isolated) and development of resistance during therapy. Patients without cultures or evident pathogens from the presumed site of infection were deemed unevaluable.The categories of eradication and presumed eradication were combined and defined as microbiologic success. Persistence was designated as microbiologic failure.

1. Meropenem-related length of mechanical ventilation
2. Meropenem-related length of ICU and hospital stay (LOS)
3. ICU and in-hospital mortality
4. Duration of meropenem treatment
5. The total dose of meropenem
6. Safety and cost effectiveness of both dosing regimens