We've just presented and published a multicenter RCT at #CCR23 and in @JAMA_current!
Continuous vs Intermittent Meropenem Administration in Critically Ill Patients with Sepsis: The #MERCYtrial!
๐ jamanetwork.com/journals/jama/โฆ
This ๐งต will explain the study in detail /11
#FOAMcc
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ฮฒ-lactams (e.g., #meropenem), are typically given intermittently, but continuous administration can provide constant serum levels and may improve outcomes.
In fact, several meta-analyses reported reduced mortality when administered continuously.
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Therefore, we conducted a multinational, double-blind, randomized controlled trial to test the hypothesis that continuous administration of #meropenem, compared with intermittent administration, would improve clinically relevant outcomes in critically ill pts with #sepsis
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P: ICU patients with sepsis or septic shock who needed new meropenem treatment
I: continuous infusion (3g/day)
C: intermittent administration (1g q8h)
O: composite of mortality and/or the emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28
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A total of 607 patients were randomized, 303 in the continuous and 304 in the intermittent arm.
The two arms are well-balanced
64 years old
61% with septic shock
Time from hospital admission to randomization = 9 days
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The daily dose of meropenem was 3 g in both groups.
At randomization, 74% received concurrent antibiotic therapy, with glycopeptide being the most common.
Among patients with identified bacteria (71%), Klebsiella and Pseudomonas are the common gram-negative species.
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The primary outcome (mortality and/or emergence of PDR/XDR bacteria) was not significantly different between the two arms (47% vs 49%; RR 0.96 [95% CI 0.81โ1.13]).
No interaction was found in any subgroup analysis.
#MERCYtrial
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No significant difference was observed in any secondary outcome (including 28-day mortality).
No adverse events related to meropenem (e.g., seizure) were reported.
#MERCYtrial
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Conclusion
In critically ill patients with sepsis, compared with intermittent administration, the continuous administration of meropenem did not improve the composite outcome of mortality and pan or extensively drug-resistance emergence.
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It's our honor to publish the results of #MERCYtrial in JAMA @JAMA_current: Continuous vs Intermittent Meropenem Administration in Critically Ill Patients with Sepsis
๐ jamanetwork.com/journals/jama/โฆ
#FOAMcc
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We thank all the patients, families, funder, investigators, and clinicians.
We also appreciate the editors/reviewers of @JAMA_current and @CritCareReviews for giving us the opportunity for the simultaneous publication/presentation.
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