Meropenem-vaborbactam is a new β-
lactam/β-lactamase inhibitor combination designed to target Klebsiella pneumoniae
carbapenemase (KPC)-producing Enterobacteriaceae.
Meropenem-vaborbactam was United States Food and Drug Administration-approved for complicated
urinary tract infections in patients 18 years of age or older. An understanding of the pharmacokinetics of
meropenem when given in combination with
vaborbactam is important to understanding the dosing of
meropenem-vaborbactam. In addition, the safety and efficacy of
meropenem-vaborbactam in a pediatric patient have yet to be described in the literature. The authors conducted a retrospective single-patient chart review for a 4-year-old male patient with
short bowel syndrome,
colostomy and gastrojejunal tube,
bronchopulmonary dysplasia, and a central line for chronic
total parenteral nutrition and hydration management, complicated with multiple central line-associated
bloodstream infections (BSIs). The patient was brought to our medical center with
fever concerning for a BSI. On day 2, the patient was started on
meropenem-vaborbactam at a dosage of 40 mg/kg every 6 hours infused over 3 hours for KPC-producing K. pneumoniae BSI.
Meropenem serum concentrations obtained on day 5 of
meropenem-vaborbactam therapy, immediately following the completion of the infusion and 1 hour after the infusion, were 51.3 and 13.6 μg/ml, respectively. Serum concentrations correlated to a volume of distribution of 0.59 L/kg and a clearance of 13.1 ml/min/kg. Repeat blood cultures remained negative, and
meropenem-vaborbactam was continued for a total of 14 days. A
meropenem-vaborbactam regimen of 40 mg/kg every 6 hours given over 3 hours was successful in providing a target attainment of 100% for
meropenem serum concentrations above the minimum inhibitory concentration for at least 40% of the dosing interval and was associated with successful
bacteremia clearance in a pediatric patient.