MERCY
Trial question
What is the role of continuous administration of meropenem in critically ill patients with sepsis?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
33.0% female
67.0% male
N = 607
607 patients (203 female, 404 male).
Inclusion criteria: critically ill adult patients with sepsis or septic shock.
Key exclusion criteria: previous therapy with carbapenem antibiotics; very low probability of survival assessed using the Simplified Acute Physiology Score II; severe immunosuppression.
Interventions
N=303 continuous administration (3 g of meropenem administered over 24 hours).
N=304 intermittent administration (1 g of meropenem administered over 30-60 minutes every 8 hours).
Primary outcome
All-cause mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28
47%
49%
49.0 %
36.8 %
24.5 %
12.3 %
0.0 %
Continuous
administration
Intermittent
administration
No significant
difference ↔
No significant difference in all-cause mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28 (47% vs. 49%; RR 0.96, 96% CI 0.81 to 1.13).
Secondary outcomes
No significant difference in death at day 90 (42% vs. 42%; RR 1, 95% CI 0.83 to 1.21).
No significant difference in median days alive and free from antibiotics at day 28 (3 days vs. 2 days; MD 0.4, 95% CI -0.9 to 1.7).
No significant difference in median days alive and free from ICU at day 28 (0 days vs. 0 days; MD 0.6, 95% CI -1 to 2.2).
Conclusion
In critically ill adult patients with sepsis or septic shock, continuous administration was not superior to intermittent administration with respect to all-cause mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28.
Reference
Giacomo Monti, Nikola Bradic, Matteo Marzaroli et al. Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis: The MERCY Randomized Clinical Trial. JAMA. 2023 Jul 11;330(2):141-151.
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