The Use of Therapeutic Drug Monitoring to Optimize Treatment of Carbapenem-Resistant Enterobacter Osteomyelitis.

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The Use of Therapeutic Drug Monitoring to Optimize Treatment of Carbapenem-Resistant Enterobacter Osteomyelitis.

Microb Drug Resist. 2015 Jul 14;

Authors: Stewart A, Graves B, Hajkowicz K, Ta K, Paterson DL

Abstract
INTRODUCTION: Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE) are becoming increasingly more prevalent and provide significant morbidity and mortality. Providing curative therapy and overcoming bacterial resistance are difficult tasks with limited antibiotic options. Alternative antibiotics and approaches to therapy are required, with often a compromise in patient outcome.
AIM: To demonstrate the effective use of therapeutic drug monitoring (TDM) in difficult-to-treat infections due to multiresistant gram-negative bacteria.
CASE PRESENTATION: A case of an elderly woman with an invasive cervical spine infection due to CRE is presented. Her protracted therapeutic course was complicated by multiple treatment failures and severe cervical spine instability. Therapeutic success, as determined by wound healing, cervical spine stability, and continued suppression of inflammatory markers, was obtained by continuous daily ertapenem infusions with TDM guiding the optimal drug dosing.
CONCLUSION: In this unusual setting, TDM was utilized successfully to achieve favorable serum antibiotic concentrations and lead to control of the infection. TDM may be a useful tool in difficult-to-treat infections caused by multiresistant bacteria.

PMID: 26171974 [PubMed - as supplied by publisher]