The evaluation of factors affecting meropenem trough level through therapeutic drug monitoring in adult patients hospitalized in anesthesiology and reanimation intensive care unit

Aim: The aim of this study is to reveal the relationship between the factors affecting the trough level (Cmin) of meropenem used in intensive care patients. Material and Method: This prospective study was carried out at İnönü University Anesthesiology and Reanimation Intensive Care Unit between 09.05.2022 and 09.03.2023. Patients over the age of 18 who were hospitalized in the intensive care unit and treated with meropenem for at least 48 hours were included in the study. On the third day of meropenem treatment, blood was drawn from the patient approximately 30 minutes before drug administration. Then, the collected blood was centrifuged, and its concentrations were analyzed by Enzyme-Linked immunosorbent Assay method. A statistical analysis was performed between the Cmin levels obtained using the Statistical Package for the Social Sciences v27.0 and the factors belonging to the patients. Results: The study included 38 patients, 26 of which were male. The mean age of the patients was 66.68±16.27. The most common diagnoses were multiple fractures, unspecified (15.79%), cardiac arrest (13.16%), and subarachnoid hemorrhage (10.53%). The highest value among the meropenem Cmin levels was found to be 0.63 mg/L, and it was determined that only the patient from whom this sample was taken was given an extended infusion. The threshold value for creatinine clearance was determined to be 50 mL/min, and there was no statistically significant difference between the groups in terms of mean Cmin levels (p= 0.651). There was a significant difference in erythrocyte count and hemoglobin values before and after meropenem treatment. These decreased after meropenem treatment compared to baseline (p<0.05). At the same time, it was determined that there was a very significant difference in C-Reactive Protein (CRP) and Sequential Organ Failure Assessment (SOFA) values. After meropenem treatment, CRP decreased and SOFA scores increased (p<0.001). The relationship between Cmin level and some factors belonging to the patients was examined and it was determined that there was no significant correlation between these factors and Cmin level (p>0.05). Conclusion: In critically ill patients, prolonged infusions of beta-lactam antibiotics may increase blood trough levels. Therapeutic drug monitoring can help evaluate treatment efficacy in this population. Keywords: clinical pharmacy, drug trough level, intensive care unit, meropenem, therapeutic drug monitoring