title: Pharmacokinetics of Continuous Infusion Meropenem With Concurrent Extracorporeal Life Support and Continuous Renal Replacement Therapy: A Case Report.
abstract: Pharmacokinetic parameters can be significantly altered for both extracorporeal life support (ECLS) and continuous renal replacement therapy (CRRT). This case report describes the pharmacokinetics of continuous-infusion meropenem in a patient on ECLS with concurrent CRRT. A 2.8-kg, 10-day-old, full-term neonate born via spontaneous vaginal delivery presented with hypothermia, lethargy, and a ~500-g weight loss from birth. She progressed to respiratory failure on hospital day 2 (HD 2) and developed sepsis, disseminated intravascular coagulation, and liver failure as a result of disseminated adenoviral infection. By HD 6, acute kidney injury was evident, with progressive fluid overload >1500 mL (+) for the admission. On HD 6 venoarterial ECLS was instituted for lung protection and fluid removal. On HD 7 she was initiated on CRRT. On HD 12, a blood culture returned positive and subsequently grew Pseudomonas aeruginosa with a minimum inhibitory concentration (MIC) for meropenem of 0.25 mg/L. She was started on vancomycin, meropenem, and amikacin. A meropenem bolus of 40 mg/kg was given, followed by a continuous infusion of 10 mg/kg/hr (240 mg/kg/day). On HD 15 (ECLS day 9) a meropenem serum concentration of 21 mcg/mL was obtained, corresponding to a clearance of 7.9 mL/kg/min. Repeat cultures from HDs 13 to 15 (ECLS days 7-9) were sterile. This meropenem regimen was successful in providing a target attainment of 100% for serum concentrations above the MIC for ≥40% of the dosing interval and was associated with a sterilization of blood in this complex patient on concurrent ECLS and CRRT circuits.
authors.affiliation: The Center for Pediatric Pharmacotherapy LLC, Pottstown, Pennsylvania ; St. Christopher's Hospital for Children, Philadelphia, Pennsylvania ; Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Cies
authors.affiliation: The Center for Pediatric Pharmacotherapy LLC, Pottstown, Pennsylvania.
authors.forename: Wayne S
authors.initials: WS
authors.lastname: Moore
authors.affiliation: St. Christopher's Hospital for Children, Philadelphia, Pennsylvania ; Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Susan B
authors.initials: SB
authors.lastname: Conley
authors.affiliation: St. Christopher's Hospital for Children, Philadelphia, Pennsylvania ; Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Mindy J
authors.initials: MJ
authors.lastname: Dickerman
authors.affiliation: St. Christopher's Hospital for Children, Philadelphia, Pennsylvania ; Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Christine
authors.initials: C
authors.lastname: Small
authors.affiliation: St. Christopher's Hospital for Children, Philadelphia, Pennsylvania ; Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Dominick
authors.initials: D
authors.lastname: Carella
authors.affiliation: St. Christopher's Hospital for Children, Philadelphia, Pennsylvania ; Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Paul
authors.initials: P
authors.lastname: Shea
authors.affiliation: St. Christopher's Hospital for Children, Philadelphia, Pennsylvania ; Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jason
authors.initials: J
authors.lastname: Parker
authors.affiliation: The Center for Pediatric Pharmacotherapy LLC, Pottstown, Pennsylvania ; NYU Langone Medical Center, New York, New York ; NYU School of Medicine, New York, New York.
authors.forename: Arun
authors.initials: A
authors.lastname: Chopra
keywords: CRRT; ECMO; carbapenem; meropenem; pediatric; pharmacodynamics; pharmacokinetic; renal