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已发表论文
药师主导的美罗培南闭环管理模式：对神经外科患者用药稳定性和疗效的影响
Authors Li T , Chen X, Xu J , Qian J , Deng P, Xue C, Yang L, Huang S, Zhang Q, Ma M, Yu Y, Tang L
Received 21 September 2025
Accepted for publication 25 January 2026
Published 2 February 2026 Volume 2026:20 569180
DOI https://doi.org/10.2147/DDDT.S569180
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Tuo Deng
Tongtong Li,1,* Xianglong Chen,1,* Jinhui Xu,1,* Jinhong Qian,2 Peng Deng,2 Chunmeng Xue,3 Lijuan Yang,1 Shenjia Huang,1 Qian Zhang,1 Mian Ma,2 Yanxia Yu,1 Lian Tang1,3
1Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, People’s Republic of China; 2Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, People’s Republic of China; 3Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Lian Tang, Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, Gusu District, Suzhou, 215002, People’s Republic of China, Tel +86 0512 6236 2325, Email tanglian716@aliyun.com Yanxia Yu, Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, Gusu District, Suzhou, 215002, People’s Republic of China, Tel +86 0512 6236 2325, Email yuyxsz@163.com
Purpose: To evaluate the impact of a pharmacist-driven closed-loop stewardship model on meropenem stability and therapeutic efficacy in neurosurgical patients with hospital-acquired pneumonia (HAP).
Patients and Methods: An interrupted time series study enrolled neurosurgical patients treated with meropenem for HAP. The patients from October 2019 to December 2021 were retrospectively collected as the control group, whereas the patients were prospectively enrolled from January 2022 to March 2025 as the intervention group. The intervention featured optimized drug preparation, prioritized administration, rapid specimen processing, real-time therapeutic drug monitoring and dynamic dose adjustments. Steady-state trough concentrations (Cmin) and open-ring metabolite (ORM) levels in serum and cerebrospinal fluid (CSF), and clinical outcomes were analyzed.
Results: A total of 227 patients was included (control group: n = 102; intervention group: n = 125). The intervention group demonstrated a significantly higher median Cmin [3.75 (1.45, 8.64) mg/L vs 0.78 (0.25, 2.74) mg/L, P < 0.001] and lower subtherapeutic exposure rate (35.48% vs 70.59%, P < 0.0001) compared to control group. The ratio of ORM/Cmin in serum [0.83 (0.62, 1.24) vs 1.97 (1.42, 2.65), P < 0.0001] and CSF [1.21 (0.84, 1.90) vs 2.05 (1.27, 2.81), P < 0.05] were also lower in the intervention group, indicating mitigated degradation. There were no significant differences in clinical response rates (72.5% vs 61.3%, P = 0.157) or bacterial eradication rates (68.1% vs 59.4%, P = 0.160). However, the bacterial eradication rates improved for Gram-negative isolates with Minimum inhibitory concentration (MIC) ≤ 8 mg/L in the intervention group than the control group (84.4% vs 69.1%, P < 0.05).
Conclusion: The closed-loop stewardship model effectively improved meropenem target concentration attainment by systematically reducing drug loss through degradation and metabolism. This optimized exposure profile correlated with improved eradication rates of Gram-negative sensitive bacteria.
Keywords: meropenem, closed-loop management of precision medication, concentration, open-ring metabolite, hospital-acquired pneumonia, acute brain injury
1Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, People’s Republic of China; 2Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, People’s Republic of China; 3Gusu School, Nanjing Medical University, Suzhou, Jiangsu, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Lian Tang, Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, Gusu District, Suzhou, 215002, People’s Republic of China, Tel +86 0512 6236 2325, Email tanglian716@aliyun.com Yanxia Yu, Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, Gusu District, Suzhou, 215002, People’s Republic of China, Tel +86 0512 6236 2325, Email yuyxsz@163.com
Purpose: To evaluate the impact of a pharmacist-driven closed-loop stewardship model on meropenem stability and therapeutic efficacy in neurosurgical patients with hospital-acquired pneumonia (HAP).
Patients and Methods: An interrupted time series study enrolled neurosurgical patients treated with meropenem for HAP. The patients from October 2019 to December 2021 were retrospectively collected as the control group, whereas the patients were prospectively enrolled from January 2022 to March 2025 as the intervention group. The intervention featured optimized drug preparation, prioritized administration, rapid specimen processing, real-time therapeutic drug monitoring and dynamic dose adjustments. Steady-state trough concentrations (Cmin) and open-ring metabolite (ORM) levels in serum and cerebrospinal fluid (CSF), and clinical outcomes were analyzed.
Results: A total of 227 patients was included (control group: n = 102; intervention group: n = 125). The intervention group demonstrated a significantly higher median Cmin [3.75 (1.45, 8.64) mg/L vs 0.78 (0.25, 2.74) mg/L, P < 0.001] and lower subtherapeutic exposure rate (35.48% vs 70.59%, P < 0.0001) compared to control group. The ratio of ORM/Cmin in serum [0.83 (0.62, 1.24) vs 1.97 (1.42, 2.65), P < 0.0001] and CSF [1.21 (0.84, 1.90) vs 2.05 (1.27, 2.81), P < 0.05] were also lower in the intervention group, indicating mitigated degradation. There were no significant differences in clinical response rates (72.5% vs 61.3%, P = 0.157) or bacterial eradication rates (68.1% vs 59.4%, P = 0.160). However, the bacterial eradication rates improved for Gram-negative isolates with Minimum inhibitory concentration (MIC) ≤ 8 mg/L in the intervention group than the control group (84.4% vs 69.1%, P < 0.05).
Conclusion: The closed-loop stewardship model effectively improved meropenem target concentration attainment by systematically reducing drug loss through degradation and metabolism. This optimized exposure profile correlated with improved eradication rates of Gram-negative sensitive bacteria.
Keywords: meropenem, closed-loop management of precision medication, concentration, open-ring metabolite, hospital-acquired pneumonia, acute brain injury