AUTHOR=Ai Ming-Ying , Chang Wei-Lun , Liu Chia-Ying 

TITLE=Mortality of continuous infusion versus intermittent bolus of meropenem: a systematic review and meta-analysis of randomized controlled trials

JOURNAL=Frontiers in Microbiology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2024.1337570

DOI=10.3389/fmicb.2024.1337570

ISSN=1664-302X

ABSTRACT=Background: Meropenem belongs to the carbapenem class, which is categorized as beta-lactam antibiotics. These antibiotics are administered in intermittent bolus doses at specific time intervals. However, the continuous infusion approach ensures a sustained drug exposure, maintaining the drug concentration above the minimum inhibitory concentration (MIC) throughout the entire treatment period. The aim of this study was to find out the association between continuous infusion of meropenem and mortality rates. Materials and Methods: We conducted a search of the PubMed/Medline, EMBASE, Cochrane Central, and ClinicalTrials.gov databases up to August 14, 2023. The six randomized controlled trials were identified and included in our analysis. The random-effects model was implemented using Comprehensive Meta-Analysis software to exam outcomes. Results: Our study included a total of 1,529 adult patients from six randomized controlled trials. The primary outcome indicated that continuous infusion of meropenem did not lead to a reduction in the mortality rate (Odds ratio = 0.844, 95% CI: 0.671-1.061, p =0.147). Secondary outcomes revealed no significant differences in ICU length of stay (LOS), ICU mortality, clinical cure or adverse events between continuous infusion and traditional intermittent bolus strategies of meropenem. Notably, we observed significant improvements in bacterial eradication (Odds ratio = 2.207, 95% CI: 1.467-3.320, p < 0.001) with continuous infusion of meropenem. Our study also suggested that performing meropenem continuous infusion may lead to better bacterial eradication effects in resistant pathogens (coefficient: 2.5175, p-value = 0.0138*). Conclusion: Continuous infusion of meropenem did not result in a decrease in the mortality rate but showed potential to improve bacterial eradication. Continuous infusion of meropenem may be particularly beneficial for achieving better bacterial eradication, especially in cases involving resistant pathogens.