title: Use of meropenem by continuous infusion to treat a patient with a Bla(kpc-2)-positive Klebsiella pneumoniae blood stream infection.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Weill Cornell Medical College, New York, New York 10065, USA. vah9004@nyp.org
authors.forename: Vanessa P
authors.initials: VP
authors.lastname: Ho
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Jenkins
authors.forename: Cheguevara I
authors.initials: CI
authors.lastname: Afaneh
authors.forename: Harma K
authors.initials: HK
authors.lastname: Turbendian
authors.forename: David P
authors.initials: DP
authors.lastname: Nicolau
authors.forename: Philip S
authors.initials: PS
authors.lastname: Barie
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D044967:Serum / Q000737:chemistry; D013845:Thienamycins / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016896:Treatment Outcome; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D001618:beta-Lactamases; C547585:beta-lactamase KPC-2, Klebsiella pneumoniae; D000077731:Meropenem