The Clinical Advantages of High Dose Meropenem/Tigecycline Combination versus Tigecycline Monotherapy against Carbapenem Resistant Enetrobacteriaceae in Septic Critically Ill Patients Who are Not Candidate to Colistimethate Sodium

Carbapenem-Resistant Enterobacteriaceae (CRE) prevalence is globally increased with the widely carbapenems used in clinical practices. The aim of this study is to evaluate the clinical usefulness of adding high dose extended infusion meropenem (2 g over 3 hours TID) to the standard dose of tigecycline (100 mg LD, 50 mg BID) in comparison to standard dose tigecycline monotherapy in CRE infected-colistin non-candidate critically ill patients. Methods: An observational review study was directed in our foundation which included 110 patients admitted to our adult ICU. All eligible patients' basic and tested data were recorded retrospectively through our institutional electronic medical records (Hakeem). All patient's continuous variables will be expressed as Mean±SD by using the independent and One Sample T-Test, respectively. Regarding categorical variables, Chi Square test will be used to express them as numbers with percentages. Results: Our eligible sample had a mean overall age of 56.1±8.75 years. 59 subjects (53.64%) were male and 51 subjects (46.36%) were female. The ICU and overall hospital stay days were significantly lower in Group I than in Group II with Mean±SD of 8.66±0.48 days and 10.3±0.58 days vs 21.6±0.50 days and 25.0±0.00 days, respectively. Regarding mortalities, the early, late, and overall 28-day ICU mortality were also significantly lower in Group I than in Group II with Number (%) of 3 (5.36%), 8 (14.29%), and 11 (19.64%) vs 14 (25.93%), 24 (44.44%), and 38 (70.37%), respectively. Conclusion: In conclusion, our study shows that high dose extended meropenem infusion may mitigate the PK/PD barriers of tigecycline in treating septic critically ill patients and increases our available options in case of non-candidacy to colistin treatment and shortage of newer anti-CRE ABs