Frontiers in Pharmacology (Oct 2024)

First case report of a vertebral osteomyelitis caused by carbapenem-resistant Enterobacter cloacae treated with imipenem/cilastatin/relebactam prolonged infusion then meropenem/vaborbactam in continuous infusion

  • Paul Laffont-Lozes,
  • Tayma Naciri,
  • Alix Pantel,
  • Alix Pantel,
  • Aurélie Martin,
  • Anne-Sophie Pruvot-Occean,
  • Vincent Haignere,
  • Paul Loubet,
  • Paul Loubet,
  • Albert Sotto,
  • Albert Sotto,
  • Romaric Larcher,
  • Romaric Larcher

DOI
https://doi.org/10.3389/fphar.2024.1347306
Journal volume & issue
Vol. 15

Abstract

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IntroductionBone and joint infections (BJIs) caused by multidrug-resistant bacteria are becoming more frequent. However, data on the use of novel β-lactam/β-lactamase inhibitors, such as imipenem/cilastatin/relebactam (I-R) and meropenem/vaborbactam (MVB), to treat BJIs is lacking. Furthermore, prolonged infusions of these β-lactams should theoretically optimize pharmacokinetic/pharmacodynamics target in these indications, but there are currently no reports on this type of infusions, especially in the setting of BJI.Case PresentationWe report a case of a vertebral osteomyelitis caused by carbapenem-resistant Enterobacter cloacae successfully treated with extended-infusion of I-R (1.25 g q6h over 2 h), then with continuous infusion of MVB (2 g q4h as over 4 h). Therapeutic drug monitoring confirmed that extended-infusion of I-R and continuous infusion of MVB achieved serum concentrations up to 12 mg/L of imipenem and 19 mg/L of meropenem, respectively.ConclusionThe favourable outcome of this patient treated for a vertebral osteomyelitis caused by carbapenem-resistant E. cloacae suggest that extended- and continuous infusions of I-R and MVB, are promising regimens for treatment of BJIs caused by carbapenem-resistant Enterobacterales.

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