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Use of meropenem by continuous infusion to treat a patient with a Bla(kpc-2)-positive Klebsiella pneumoniae blood stream infection.

AbstractBACKGROUND:
Gram-negative bacterial resistance to antibiotics is of increasing concern. Carbapenem resistance among strains of Klebsiella pneumoniae is a relatively new phenomenon. Resistance attributable to production of carbapenemases is notoriously difficult to combat.
METHODS:
Case report and review of the pertinent English-language literature.
RESULTS:
A patient, hospitalized for aortic dissection complicated by intra-abdominal catastrophe and acute kidney injury, developed bacteremia exhibiting meropenem non-susceptibility secondary to expression of bla(KPC-2). High-dose, continuous-infusion meropenem achieved serum drug concentrations above the minimum inhibitory concentration and eradicated the infection.
CONCLUSION:
This is the first report of a meropenem-non-susceptible carbapenamase-positive Klebsiella pneumoniae blood stream infection treated successfully with high-dose, continuous-infusion meropenem. Application of this regimen in certain patients, such as those with mild-to-moderate renal insufficiency, may be a reasonable option for multi-drug-resistant nosocomial infections.
AuthorsVanessa P Ho, Stephen G Jenkins, Cheguevara I Afaneh, Harma K Turbendian, David P Nicolau, Philip S Barie
JournalSurgical infections (Surg Infect (Larchmt)) Vol. 12 Issue 4 Pg. 325-7 (Aug 2011) ISSN: 1557-8674 [Electronic] United States
PMID21859337 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Anti-Bacterial Agents
  • Thienamycins
  • beta-Lactamases
  • beta-lactamase KPC-2, Klebsiella pneumoniae
  • Meropenem
Topics
  • Anti-Bacterial Agents (administration & dosage, pharmacokinetics)
  • Bacteremia (drug therapy, microbiology)
  • Humans
  • Infusions, Intravenous (methods)
  • Klebsiella Infections (drug therapy, microbiology)
  • Klebsiella pneumoniae (enzymology, isolation & purification)
  • Male
  • Meropenem
  • Microbial Sensitivity Tests
  • Middle Aged
  • Serum (chemistry)
  • Thienamycins (administration & dosage, pharmacokinetics)
  • Treatment Outcome
  • beta-Lactam Resistance
  • beta-Lactamases (metabolism)

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