Evaluation of the rational use of meropenem: A retrospective study in southern Iran
Evaluation of the rational use of meropenem: A retrospective study in southern Iran
Sahar Sanjarian,1,*Mozhdeh Memarizadeh,2Seyed Aliakbar Banihashemi,3Zahra Sepehr,4Ahmad Gheisari,5
1. School of Medicine, Islamic Azad University of Medical Sciences, Kazerun, Iran 2. School of Medicine, Islamic Azad University of Medical Sciences, Kazerun, Iran 3. Kazeroun Branch, College of Medicine, Islamic Azad University, Kazeroun, Iran 4. Social Security Organization, Shahid Beheshti Hospital, Pharmacology Unit, Shiraz, Iran 5. School of Medicine, Islamic Azad University of Medical Sciences, Kazerun, Iran
Introduction: Inappropriate use of antibiotics results in the emergence of antimicrobial resistance. This study aimed to evaluate the appropriate use of meropenem in terms of initial indication and requiring renal dose adjustment in Shahid Beheshti Hospital, Shiraz, Iran.
Methods: This retrospective observational study was carried out in Shiraz from April 2018 to March 2019. A total of 159 patients of all age groups who received at least one dose of meropenem were included. Required data were obtained through paper-based and electronic medical records. The analysis was performed using descriptive-analytical methods.
Results: Based on the results, meropenem was mostly prescribed for the age range of 60-79 years (32.7%), followed by the age group of 80-99 years (31.4%). The initiation of meropenem therapy was inappropriate in 20.7% of patients. The most frequent indication for meropenem utilization was pneumonia (23.8%), followed by complicated skin and soft tissue infections, and sepsis. (16.3% and 15.0% respectively). Regarding hospital wards, the highest proportion of meropenem was prescribed in internal medicine wards. Most prescriptions (97.5%) were initiated empirically and only 2.5 % were based on culture results. Out of the 84 culture and sensitivity tests, only 12 (14.2%) results confirmed the susceptibility to meropenem. 36 of 84 (42.8%) specimens for microbiological testing were obtained prior to commencing any antimicrobial therapy. The most predominant isolated microorganism derived from cultures was Escherichia coli, followed by Staphylococcus aureus, and Acinetobacter baumannii. Dose adjustment due to renal function impairment was required for 54 patients. Despite that, only 20 (37.0%) of patients received adjusted doses.
Conclusion: The rate of inappropriateness in the study, especially regarding dose adjustment and the number of requests for culture and susceptibility tests, highlights the necessity of implementing new strategies to enhance the rational use of broad-spectrum antimicrobial agents.