Background: Meropenem is a second generation carbapenem with a broad spectrum of activity. As such, it is prone to misuse and this raises concern about the emergence of microbial resistance to this agent in Kenya and beyond. Resistance to meropenem is challenging due to the high prevalence of infections, irrational use and inadequate antimicrobial susceptibility testing.
Objectives: The study aimed to describe patterns of use and resistance to meropenem at Kenyatta National Hospital. The beliefs and attitudes of clinicians with regard to prescribing of meropenem was also assessed.
Methods: A retrospective review of prescriptions and culture and sensitivity results was conducted for the period January 2016 and December 2017. A cross-sectional study on meropenem prescribing practices by clinicians was also conducted. Clinicians were interviewed with the use of a structured questionnaire. Abstracted data were subjected to descriptive and inferential data analysis was done using SPSS version 13 software.
Results: Meningitis, (45, 27.6%) and severe pneumonia, (41, 25.2%) were the major indications in children while soft tissue infections, (75, 26%) in adults. Meropenem was used empirically in 77% of the patients. Gram-negative bacteria were the main isolates on culture and sensitivity testing (97.6%). Acinetobacter baumannii (90.0%) and Pseudomonas aeruginosa (55.6%) had the highest prevalence of resistant strains. Escherichia coli were the most susceptible, (921, 84.2%). Most clinicians, (29, 74.4%) advocated for cessation of empirical use of meropenem. Clinicians mostly relied on advice from an Infectious Disease Specialist (22, 56.4%) and senior colleagues (20, 51.3%). The Pharmacists, (5, 12.8%) were the least accessible to provide guidance on meropenem prescribing. Inappropriate selection, (22, 56.4%) and over-prescription, (28, 71.8%) of meropenem were the most prevalent medication use problems.
Conclusions: Meropenem was mainly used empirically. Antimicrobial stewardship is needed to promote its use.
