title: Even high-dose extended infusions may not yield desired concentrations of β-lactams: the value of therapeutic drug monitoring.
abstract: A 35-year-old patient in intensive care with severe burn injury developed episodes of sepsis. Blood culture yielded a multidrug-resistant Pseudomonas aeruginosa and treatment was commenced with amikacin (minimum inhibitory concentration (MIC) 2-4 mg/L, dose 20 mg/kg adjusted body weight 24-hourly) and meropenem (MIC 8 mg/L, dose 2 g IV 8-hourly and later 6-hourly). Despite the use of extended infusions with β-lactam therapeutic drug monitoring and doses that were more than 2.5 times higher than standard meropenem doses, resistance emerged. This case report describes the application of therapeutic drug monitoring to optimize β-lactam therapy in a difficult-to-treat critically ill patient.
authors.affiliation: From the Burns Trauma and Critical Care Research Centre, University of Queensland , Queensland , Australia.
authors.forename: Menino Osbert
authors.initials: MO
authors.lastname: Cotta
authors.forename: Belinda
authors.initials: B
authors.lastname: Gowen
authors.forename: Natasha
authors.initials: N
authors.lastname: Truloff
authors.forename: Evan
authors.initials: E
authors.lastname: Bursle
authors.forename: Brett
authors.initials: B
authors.lastname: McWhinney
authors.forename: Jacobus P J
authors.initials: JP
authors.lastname: Ungerer
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
mesh_terms: D000328:Adult; D000583:Amikacin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016638:Critical Illness / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D018805:Sepsis / Q000188:drug therapy* / Q000382:microbiology; D013845:Thienamycins / Q000008:administration & dosage; D047090:beta-Lactams / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D047090:beta-Lactams; D000583:Amikacin; D000077731:Meropenem
keywords: critically ill; extended infusions; therapeutic drug monitoring; β-Lactams