Microbiologic clearance following transition from standard infusion piperacillin-tazobactam to extended-infusion for persistent Gram-negative bacteremia and possible endocarditis: a case report and review of the literature

D'Agostino, Carly, Rhodes, Nathaniel J., Skoglund, Erik, Roberts, Jason A. and Scheetz, Marc H. (2015) Microbiologic clearance following transition from standard infusion piperacillin-tazobactam to extended-infusion for persistent Gram-negative bacteremia and possible endocarditis: a case report and review of the literature. Journal of Infection and Chemotherapy, 21 10: 742-746. doi:10.1016/j.jiac.2015.05.010


Author D'Agostino, Carly
Rhodes, Nathaniel J.
Skoglund, Erik
Roberts, Jason A.
Scheetz, Marc H.
Title Microbiologic clearance following transition from standard infusion piperacillin-tazobactam to extended-infusion for persistent Gram-negative bacteremia and possible endocarditis: a case report and review of the literature
Journal name Journal of Infection and Chemotherapy   Check publisher's open access policy
ISSN 1437-7780
1341-321X
Publication date 2015-06-09
Year available 2015
Sub-type Article (original research)
DOI 10.1016/j.jiac.2015.05.010
Open Access Status Not yet assessed
Volume 21
Issue 10
Start page 742
End page 746
Total pages 5
Place of publication Tokyo, Japan
Publisher Springer
Language eng
Formatted abstract
Introduction:  We sought to describe a case of pharmacodynamically-optimized dosing of piperacillin-tazobactam in a patient that cleared their infections after treatment with high-dose, extended-infusion piperacillin-tazobactam and summarize the literature on the benefits of extended-infusion of beta-lactams.

Case report:  At an outside hospital, a 78 year-old male presented with fevers and shortness of breath. He was empirically initiated on standard doses of vancomycin and piperacillin-tazobactam for suspected pneumonia and sepsis. Blood and sputum cultures identified Elizabethkingia meningosepticum sensitive only to piperacillin-tazobactam by E-test susceptibility testing. After 10 days of empiric therapy with piperacillin-tazobactam dosed at 3.375 g IV every 8 h over 30 min, the patient transferred to our institution and was initiated on piperacillin-tazobactam at 3.375 g IV every 8 h administered as a 4 h infusion. The patient failed to improve; piperacillin-tazobactam was changed to 4.5 g IV over 4 h every 8 h and later changed to the hospital protocol dose of 3.375 g IV over 4 h every 6 h. The patient achieved negative blood cultures within 24 h of optimized dosing.

Discussion:  We present the first case to our knowledge that describes failure to respond and subsequent response within a single patient where beta-lactam dosing was altered to optimize pharmacokinetics and pharmacodynamics (PK-PD). Our patient received non-standard dose-escalation for piperacillin-tazobactam. Drug exposure was estimated post-hoc utilizing robust mathematical simulations to describe alterations in disposition over time. This case demonstrates that extended-infusion administration of beta-lactams may provide improved microbiological activity.
Keyword Extended-infusion
Gram-negative bloodstream infection
Minimum inhibitory concentration
Pharmacokinetic model
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
School of Pharmacy Publications
 
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