title: The Use of Therapeutic Drug Monitoring to Optimize Treatment of Carbapenem-Resistant Enterobacter Osteomyelitis.
abstract: BACKGROUND
  Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE) are becoming increasingly more prevalent and provide significant morbidity and mortality. Providing curative therapy and overcoming bacterial resistance are difficult tasks with limited antibiotic options. Alternative antibiotics and approaches to therapy are required, with often a compromise in patient outcome.
  
  
  OBJECTIVE
  To demonstrate the effective use of therapeutic drug monitoring (TDM) in difficult-to-treat infections due to multiresistant gram-negative bacteria.
  
  
  METHODS
  A case of an elderly woman with an invasive cervical spine infection due to CRE is presented. Her protracted therapeutic course was complicated by multiple treatment failures and severe cervical spine instability. Therapeutic success, as determined by wound healing, cervical spine stability, and continued suppression of inflammatory markers, was obtained by continuous daily ertapenem infusions with TDM guiding the optimal drug dosing.
  
  
  CONCLUSIONS
  In this unusual setting, TDM was utilized successfully to achieve favorable serum antibiotic concentrations and lead to control of the infection. TDM may be a useful tool in difficult-to-treat infections caused by multiresistant bacteria.
authors.affiliation: 1 Unit of Infectious Diseases, Royal Brisbane and Women's Hospital , Herston, Queensland, Australia .
authors.forename: Adam
authors.initials: A
authors.lastname: Stewart
authors.affiliation: 1 Unit of Infectious Diseases, Royal Brisbane and Women's Hospital , Herston, Queensland, Australia .
authors.forename: Bianca
authors.initials: B
authors.lastname: Graves
authors.affiliation: 1 Unit of Infectious Diseases, Royal Brisbane and Women's Hospital , Herston, Queensland, Australia .
authors.forename: Krispin
authors.initials: K
authors.lastname: Hajkowicz
authors.affiliation: 1 Unit of Infectious Diseases, Royal Brisbane and Women's Hospital , Herston, Queensland, Australia .
authors.forename: Kim
authors.initials: K
authors.lastname: Ta
authors.affiliation: 1 Unit of Infectious Diseases, Royal Brisbane and Women's Hospital , Herston, Queensland, Australia .|2 Centre for Clinical Research, The University of Queensland , Herston, Queensland, Australia .
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
mesh_terms: D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D016903:Drug Monitoring; D024901:Drug Resistance, Multiple, Bacterial; D016972:Enterobacter cloacae / Q000187:drug effects / Q000254:growth & development / Q000472:pathogenicity; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D000077727:Ertapenem; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use; D006801:Humans; D000077731:Meropenem; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D013212:Staphylococcus epidermidis / Q000187:drug effects / Q000254:growth & development / Q000472:pathogenicity; D013845:Thienamycins / Q000627:therapeutic use; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D047090:beta-Lactams; D005578:Fosfomycin; D000583:Amikacin; D002097:C-Reactive Protein; D000077731:Meropenem; D000077727:Ertapenem