Adequacy and effectiveness of empirical antibacterial
therapy of severe
nosocomial infections with
meropenem vs. combined regimens of antibacterial
therapy were investigated and the ratio of the cost and effectiveness of the compared regimens was evaluated. A prospective, randomized, open, comparative study of two initiative regimens of empirical antibacterial
therapy of severe
nosocomial infections was performed:
meropenem in a daily dose of 1.5-3 g and the standard regimen with the use of betalactams and
fluoroquinolones in combination with
aminoglycosides and/or
metronidazole. Patients with recorded diagnosis of
nosocomial pneumonia (including the
ventilator-associated one) or abdominal
infection with the signs of
severe sepsis and severity of APACHE II > 14 were enrolled. The patients were stratified into 2 groups subject to the disease severity, i.e. APACHE II 15-20 and APACHE II 21-25. One hundred thirty five out of 166 patients with recorded
nosocomial infection were included into the final estimate of the
therapy adequacy and effectiveness (Protocol Analysis): 62 patients were treated with
meropenem and in the treatment of 73 patients the standard antibacterial
therapy was used. In the group of the patients treated with
meropenem there were stated significantly higher clinical effectiveness (recovery in 80.6% of the patients vs. the control of 46.6%, p < 0.01) and pathogen eradication (89.6 and 48.1% respectively, p < 0.01). The difference in the clinical and bacteriological effectiveness of
meropenem and the standard
therapy was more evident in the subgroups of more severe patients (APACHE > 20). With the use of
meropenem the probability of recovery from
nosocomial infection was significantly higher (RR 1.73-1.94, p < 0.001) vs. the control.
Meropenem provided significantly higher eradication of the pathogens: P. aeruginosa (88 and 40% respectively, p = 0.007), E. coli (100 and 46.7%, p = 0.003), Acinetobacter spp. (90.9 and 40%, p = 0.02). The antibacterial
therapy with the use of
meropenem was assessed as adequate in 51 out of 56 patients (91.1%), that was 3 times as frequent as with the use of the standard antibacterial
therapy (33.9%). The cost-effectiveness coefficient with the use of
meropenem was 2.2 times lower vs. the control. Therefore, the empirical
therapy of severe
nosocomial infections with
meropenem proved to be more adequate and from the economic viewpoint more advantageous vs. the standard combined regimens of antibacterial
therapy, that was evident from significantly higher clinical and bacteriological efficacy of the treatment and decrease of the terms of the patients hospitalization in intensive care units (on the average by 5 days).