Microbiologic clearance following transition from standard infusion piperacillin-tazobactam to extended-infusion for persistent Gram-negative bacteremia and possible endocarditis: A case report and review of the literature.

Abstract

INTRODUCTION:

We sought to describe a case of pharmacodynamically-optimized dosing of piperacillin-tazobactam in a patient that cleared their infections after treatment with high-dose, extended-infusion piperacillin-tazobactam and summarize the literature on the benefits of extended-infusion of beta-lactams.

CASE REPORT:

At an outside hospital, a 78 year-old male presented with fevers and shortness of breath. He was empirically initiated on standard doses of vancomycin and piperacillin-tazobactam for suspected pneumonia and sepsis. Blood and sputum cultures identified Elizabethkingia meningosepticum sensitive only to piperacillin-tazobactam by E-test susceptibility testing. After 10 days of empiric therapy with piperacillin-tazobactam dosed at 3.375 g IV every 8 h over 30 min, the patient transferred to our institution and was initiated on piperacillin-tazobactam at 3.375 g IV every 8 h administered as a 4 h infusion. The patient failed to improve; piperacillin-tazobactam was changed to 4.5 g IV over 4 h every 8 h and later changed to the hospital protocol dose of 3.375 g IV over 4 h every 6 h. The patient achieved negative blood cultures within 24 h of optimized dosing.

DISCUSSION:

We present the first case to our knowledge that describes failure to respond and subsequent response within a single patient where beta-lactam dosing was altered to optimize pharmacokinetics and pharmacodynamics (PK-PD). Our patient received non-standard dose-escalation for piperacillin-tazobactam. Drug exposure was estimated post-hoc utilizing robust mathematical simulations to describe alterations in disposition over time. This case demonstrates that extended-infusion administration of beta-lactams may provide improved microbiological activity.

• Authors: Carly D'Agostino, Nathaniel J Rhodes, Erik Skoglund, Jason A Roberts, Marc H Scheetz
• Journal: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (J Infect Chemother) Vol. 21 Issue 10 Pg. 742-6 (Oct 2015) ISSN: 1437-7780 [Electronic] Netherlands
• PMID: 26143049 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2015. Published by Elsevier Ltd.

Chemical References

• Anti-Bacterial Agents
• beta-Lactams
• Piperacillin, Tazobactam Drug Combination
• Penicillanic Acid
• beta-Lactamases
• beta-lactamase GOB-1, Elizabethkingia meningoseptica
• Piperacillin

Topics

• Aged
• Anti-Bacterial Agents (administration & dosage)
• Bacteremia (drug therapy, etiology)
• Endocarditis (etiology, therapy)
• Gram-Negative Bacterial Infections (complications, drug therapy)
• Humans
• Infusions, Intravenous
• Male
• Penicillanic Acid (administration & dosage, analogs & derivatives)
• Piperacillin (administration & dosage)
• Piperacillin, Tazobactam Drug Combination
• beta-Lactamases (blood)
• beta-Lactams (therapeutic use)