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4CPS-061 Extended infusion of meropenem in a neonate with complicated klebsiella pneumoniae meningitis
  1. MG Lopez Ramos1,
  2. Á Pertierra Cortada2,
  3. A Alarcón Allen2,
  4. N Carreras Blesa2,
  5. B Palenzuela Afonso2,
  6. S Luque Pardos3,
  7. S Grau Cerrato3,
  8. R Farré Riba1
  1. 1Hospital Sant Joan de Déu, Pharmacy, Esplugues de Llobregat Barcelona, Spain
  2. 2Hospital Sant Joan de Déu, Neonatology, Esplugues de Llobregat Barcelona, Spain
  3. 3Hospital del Mar, Pharmacy, Barcelona, Spain


Background Extended infusion of beta-lactam antibiotics is aimed at achieving microbiological eradication and clinical resolution of complicated bacterial infections. For meropenem, the best predictor of bacterial killing is the time over which free-drug concentration exceeds 4–6xMIC of the microorganism (desirable 40% fT >MIC).

Purpose To describe the course and monitoring of prolonged treatment with meropenem by extended infusion of 4 hours in a neonate with ventriculitis due to ESBL-producing Klebsiella pneumoniae.

Material and methods We present the case of a 25 weeks’ preterm newborn, who presented with a septic episode with clinical, laboratory and ultrasonographic signs of ventriculitis at 93 days of age, in February 2018.Treatment was started with meropenem 40 mg/kg/8 hour, in an extended infusion of 4 hours. Concentrations of meropenem were determined in plasma and CSF samples before the administration of a dose (Cmin), once steady-state equilibrium was reached. For the quantification of the levels, high-performance liquid chromatography validated techniques were used.

Results ESBL-producing Klebsiella pneumoniae sensitive to carbapenems (MIC Meropenem <1 mg/L) was isolated from CSF cultures. From the beginning of meropenem treatment, CSF showed progressive improvement in inflammatory parameters, and the microorganism was not isolated after 2 days of treatment. Meropenem levels in plasma and CSF were determined at 4 weeks of treatment, which were 7.6 mg/L (pre-dose) in plasma and 4.7 mg/L in CSF. These levels showed an excellent penetration of the antibiotic in CSF (CSF/plasma concentration ratio of 0.62), ensuring a time above MIC>100% in both plasma and CSF. Likewise, no potentially toxic levels were observed despite a prolonged and extended infusion strategy. The patient continued treatment until completing 8 weeks. The ventricular drain was replaced by a ventriculo-peritoneal shunt after 62 days. Clinically, the patient showed progressive improvement in neurological status. However, in view of the risk of neurodevelopmental impairment, the infant is currently under outpatient follow-up.

Conclusion With the dosing strategy used, optimal concentrations of meropenem were achieved, which allowed reaching the PK/PD index of time >4 times the MIC during 100% of the dose interval, both in plasma and in CSF.

The extended infusion of meropenem in 4 hours in our patient showed criteria of efficacy and the safety of prolonged treatment.

Reference and/or acknowledgements Conventional versus prolonged infusion of meropenem in neonates with gram-negative late-onset sepsis: a randomized controlled trial. Pediatr Infect Dis J 2017;36.

No conflict of interest.

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