title: Success With Extended-Infusion Meropenem After Recurrence of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis in an Adolescent.
abstract: A 13-year-old female experienced a recurrence of baclofen pump-related central nervous system (CNS) infection caused by Achromobacter, despite absence of retained foreign material. Due to the failure of meropenem (120 mg/kg/d in divided doses every 8 hours and infused over 30 minutes) in the initial infection, the dose was infused over 4 hours during the recurrence. Meropenem is an antibiotic for which efficacy is time dependent, and 4-hour versus 30-minute infusions have been shown to prolong the time the concentration of the antibiotic exceeds the minimum inhibitory concentration (MIC) of the organism at the site of infection (T>MIC). Meropenem serum concentrations were obtained and indicated that T>MIC was at least 75% of the dosing interval. Our patient improved with no noted recurrences or adverse effects on the extended-infusion meropenem regimen. Utilization of extended-infusion beta-lactam dosing whenever possible in the treatment of serious infections caused by gram-negative organisms should be considered, as this dosing appears to be safe and improves the probability of achieving pharmacokinetic/pharmacodynamic goals.
authors.affiliation: Department of Pharmacy Practice, Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA Department of Pharmacy, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease, Indiana University School of Medicine, Indianapolis, IN, USA knichol4@iuhealth.org.
authors.forename: Kristen R
authors.initials: KR
authors.lastname: Nichols
authors.affiliation: Department of Pharmacy Practice, Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Knoderer
authors.affiliation: Department of Pharmacy Practice, Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA Nicholas G. Jackson was a PharmD Candidate at Butler University at the time of writing this manuscript, he has since graduated.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Jackson
authors.affiliation: Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Manaloor
authors.affiliation: Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Christenson
mesh_terms: D042441:Achromobacter denitrificans / Q000302:isolation & purification*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001418:Baclofen / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D007278:Injections, Spinal; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D012008:Recurrence; D013845:Thienamycins / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D009125:Muscle Relaxants, Central; D013845:Thienamycins; D000077731:Meropenem; D001418:Baclofen
keywords: Achromobacter; device infection; meningitis; meropenem; pharmacodynamics