Success With Extended-Infusion Meropenem After Recurrence of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis in an Adolescent

Abstract

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 betalactam 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.2

Enigmatic Achromobacter

“…Инфекции дыхательных путей [65][66][67] Инфекции мочевыводящих путей, включая абсцессы почек и паранефральные абсцессы [68][69][70] Инфекции кровотока [71,72] Менингиты, абсцесс мозга [73,74] Абсцессы печени [5] Панкреатиты [75] Раневые инфекции, поражения кожи и подкожной клетчатки [75][76][77] Девайсассоциированные инфекции [78] Эндокардиты [79][80][81] Медиастиниты [4] Поражения ЛОРорганов (синуситы, отиты) [82,83] Поражения органа зрения (эндофтальмиты, кератиты) [84,85] Перитониты, абсцессы брюшной полости и забрюшин ного пространства [86,87] Остеомиелит…”

Proteomic identification of Axc, a novel beta-lactamase with carbapenemase activity in a meropenem-resistant clinical isolate of Achromobacter xylosoxidans

“…A. xylosoxidans is notorious for its intrinsic high level of resistance, especially towards penicillins and cephalosporins 14 – 16 . In general, carbapenem resistance in A. xylosoxidans is not widespread and as a result meropenem treatment is routinely applied, even in the case of recurring infections 17 , 18 . Though carbapenem resistance is observed, specifically for meropenem 19 , there are few reports on the mechanism of carbapenemase resistance in A. xylosoxidans .…”