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 continuousinfusion 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.

Peramivir for Influenza A and B Viral Infections: A Pharmacokinetic Case Series

“…These pharmacokinetic alterations are not unexpected as similar changes have previously been described in the PICU setting . As TDM becomes more common to the practice of caring for critically ill children, recognition of pharmacokinetic variations similar to those described here will most likely become customary.…”

Population Pharmacokinetics and Pharmacodynamic Target Attainment of Meropenem in Critically Ill Young Children

“…16 However, this dosage regimen, in addition to standard doses of other β-lactams, has been shown to be suboptimal in critically ill children in certain scenarios, such as severe sepsis and shock, burns, and when extracorporeal therapies are employed. [5][6][7]9,17 Therefore, the aim of this study was to assess the population PK and PD target attainment of meropenem in children admitted to the PICU who underwent routine therapeutic drug monitoring of meropenem for dosage optimization.…”

Dosage Regimens for Meropenem in Children with Pseudomonas Infections Do Not Meet Serum Concentration Targets

“…It is commonly used for treatment of serious infections, including intra‐abdominal infections and meningitis in both adult and pediatric patients. The pharmacokinetics (PKs) and pharmacodynamics (PDs) of meropenem have been assessed in pediatric patients . Smith et al .…”

“…The pharmacokinetics (PKs) and pharmacodynamics (PDs) of meropenem have been assessed in pediatric patients. [1][2][3][4][5][6][7][8][9][10] reported that meropenem disposition in pediatric patients < 3 months of age can best be described by a one-compartment model with weight, albumin, serum creatinine, and postmenstrual age being significant covariates. On the other hand, Blumer et al, 1 Parker et al, 9 Du et al, 6 and Ohata et al,8 reported that meropenem disposition in children and older infants follows a two-compartment model with weight, 6,8,9 creatinine clearance, 6,9 and postnatal age 6,9 being significant covariates.…”