Clinical outcomes and mortality rate among critically ill patients with sepsis or septic shock treated with meropenem

Abstract

Sepsis and septic shock are associated with high mortality. Meropenem is currently used as empirical therapy in patients with sepsis and septic shock. The objectives of this study were 1) to study the causative pathogen of sepsis or septic shock in patients in intensive care units (ICU) 2) to evaluate the clinical outcomes of patients 3) to study factors associated with mortality and 4) to study the relationship between the delta mSOFA score (the changing of mSOFA scores at days after received meropenem and mSOFA score at day 1) and mortality in patients who received meropenem. This retrospective observational study was performed at Phra Phutthabat Hospital from January 2018 to November 2021. Data was collected on a total of 74 patients who met the inclusion criteria. The mSOFA scores were collected on days 1, 2, 4, 7 and 10 of the meropenem treatment. Mortality rates were evaluated on days 14 and 28. The most frequently identified pathogens were Escherichia coli (35.1%), carbapenem-resistant Acinetobacter baumannii (20.3%), and Klebsiella pneumoniae (18.9%). The 14 and 28 day-mortality rates were 25.7% and 39.2%, respectively. From the multivariable analysis, we found that the significant factors affecting the 28-day mortality were the delta mSOFA between day 4 and day 1 ≤-1 (Odd ratio; OR 0.02, 95% CI [0.00,0.20]), septic shock (OR 9.15, 95% CI [1.57,53.26]), and the appropriate use of meropenem according to susceptibility testing results (OR 0.01, 95% CI [0.00,0.10]). In conclusion, this study found that patients who were treated with meropenem for sepsis or septic shock had a high mortality rate. In addition, appropriate use of meropenem, patients’ conditions, and severity of illness were risk factors for the high mortality rate