Poster
PHARMACOKINETICS OF CONTINUOUS INFUSION MEROPENEM WITH EXTRA-CORPOREAL LIFE SUPPORT AND CRRT
Critical care medicine, v 42, pp A1630-A1631
Dec 2014
Abstract
Learning Objectives: Pharmacokinetic (PK) parameters such as the volume of distribution (Vd) and clearance (CL) can be significantly altered for individuals receiving extra-corporeal life support (ECLS) in addition to continuous renal replacement therapy (CRRT). Therefore, an understanding of the PK changes in critically ill children on ECLS and CRRT is crucial to determining an optimal anti-microbial regimen. A 2.8 kg, 10 day old full-term infant born via spontaneous vaginal delivery who presented with hypothermia, lethargy, and a ~ 500 gram weight loss from birth and was admitted to rule out a serious bacterial infection. She was found to have adenovirus (+). Her respiratory status worsened and she progressed to respiratory failure on HD#2. She further progressed to sepsis, DIC, and liver failure as a result of disseminated adenoviral infection. By HD#6, she started to develop acute kidney injury (AKI) and was >1500 mL (+) for the admission. On HD6-7 she was placed on ECLS for lung protection and to facilitate 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 for meropenem of 0.25 mcg/mL. As a result of the positive blood culture, she was initiated on a regimen of vancomycin, meropenem, and amikacin. Meropenem was started with a 40 mg/kg bolus given over 30 minutes after which a continuous infusion of 10 mg/kg/hour (240 mg/kg/day) was initiated. On HD 15 (ECLS day 9) a meropenem of 21 mcg/mL was obtained, corresponding to a clearance of 7.9 mL/kg/minute, drastically higher compared with 4 mL/kg/min reported in the package insert. Repeat cultures from HD 13–15 (ECLS day 7–9) were sterile.
Conclusion: A meropenem regimen of a 40 mg/kg bolus followed by a continuous infusion of 240 mg/kg/day was successful in providing a target attainment of 100% for serum concentrations above the MIC for at least 40% of the dosing interval and was associated with a sterilization of blood in this complex patient on concurrent ECLS and CRRT circuits.
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Details
- Title
- PHARMACOKINETICS OF CONTINUOUS INFUSION MEROPENEM WITH EXTRA-CORPOREAL LIFE SUPPORT AND CRRT
- Creators
- Jeffrey Cies - St. Christopher's Hospital for ChildrenWayne Moore - DuPontMindy Dickerman - St. Christopher's Hospital for ChildrenChristine Small - St. Christopher's Hospital for ChildrenDominick Carella - St. Christopher's Hospital for ChildrenPaul Shea - Anna Needs Neuroblastoma AnswersJason Parker - St. Christopher's Hospital for ChildrenArun Chopra - St. Christopher's Hospital for Children
- Publication Details
- Critical care medicine, v 42, pp A1630-A1631
- Publisher
- Lippincott
- Number of pages
- 2
- Resource Type
- Poster
- Language
- English
- Academic Unit
- Pediatrics; College of Medicine
- Other Identifier
- 991021930914304721