Objective: To evaluate the appropriateness of empiric initiation of meropenem in the intensive care unit (ICU) and to determine the agreement between internal medicine (IM) residents and infectious diseases (ID) physicians/pharmacists on appropriateness.
Design: Retrospective observational study.
Setting: ICU in a tertiary care community teaching hospital.
Participants: Adult patients admitted to the ICU and started empirically on meropenem between April 1 and October 31, 2021.
Methods: Meropenem usage was categorized as appropriate or inappropriate according to criteria developed from previously published indications and modified by ID physicians/pharmacists to reflect local practices. Two investigators (an IM resident and either an ID physician or pharmacist) assessed the appropriateness, with a second ID physician resolving any disagreements. Inter-rater reliability was measured using the kappa statistic.
Results: Ninety-seven participants were enrolled, with a mean age of 68 (SD, 17.0) years. Pneumonia was the most common infection (30.9%). Among the participants, 92.8% received an ID consultation, with 55.6% of these occurring before meropenem initiation. IM residents deemed 56.7% of meropenem administrations appropriate, whereas an ID physician/pharmacist deemed only 48.5% appropriate, agreeing on 79.4% of cases (kappa statistic 0.59, <.001). After a third reviewer's assessment was included, agreement between the resident and at least one of the two reviewers reached 90.7% (kappa 0.81, <.001).
Conclusions: Approximately half of empiric meropenem started in the ICU was deemed inappropriate using institution-specific criteria. There was good agreement between IM residents and ID physicians/pharmacists on meropenem appropriateness. IM residents could contribute to antimicrobial stewardship efforts, like prospective audit and feedback, using standardized criteria for appropriateness.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11505016 | PMC |
| http://dx.doi.org/10.1017/ash.2024.410 | DOI Listing |
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